Financial Counselor II (PBS)

Kaiser Permanente; Downey (CA); On-site; USD 55,000 - 75,000; Full time

Job summary

Kaiser Permanente in Downey, CA seeks a Financial Counselor II to provide financial counseling at the point of service, determine payer sources for self-pay accounts and verify coverage, eligibility, and pre-authorization for inpatient and outpatient services.

You will assist with MFAP applications, collect co-pays, and coordinate with social services, billing, and care coordinators, while ensuring documentation is complete and accurate.

Qualifications

• Minimum three (3) years of relevant experience in Health Care billing, collections or Financial Counseling or equivalent.
• Knowledge of government programs and alternate payer sources (Workers Compensation, TPL, COB, Commercial, etc.).
• Ability to verify coverage, eligibility and pre-authorization for services and assist with MFAP workflow.
• Excellent communication and interpersonal skills, with the ability to work independently.

Responsibilities

• Upholds Kaiser Permanente policies and procedures and determines MFAP eligibility and payment arrangements.
• Identify alternate payer linkages or potential TPL or Workers' Compensation cases; refer as appropriate.
• Verify coverage on potential COB (members) cases by calling insurance carriers.
• Assists with collection of co-pays, Medi-Cal SOC, Conversion dues, non-member deposits, etc.
• Verifies eligibility for KP Membership through government programs using online systems.
• Verify pre-authorization for services from insurance carriers for outpatient and inpatient.
• Interviews patients to obtain payer source and financial/demographic information.
• Complete and process Third Party insurance claim forms and provide reports to management.

Skills

Communication skills

Interpersonal skills

Independent work

Healthcare billing

Government programs

Alternate payer sources

Computer keyboard

Education

High School Diploma

Job description

Job Summary:

Under direct supervision, at the point of service provides financial counseling to patients in a personal interview to create a payer source for Inpatient and Outpatient self-pay accounts. Identifies potential third party liability, Workers Compensation, Commercial, COB, Medicare and Medi-Cal. Verifies coverage, eligibility, pre-authorization, billing addresses and assists with collection of co-pays, Medi-Cal Share of Cost (SOC), conversion dues and non-member deposits. Ensures all documentation is complete and assists with questionable eligibility. The Financial Counselor II screens and directs correspondence, conducts periodic desk audits to identify backlogs and provides feedback to the Department Administrator.

Essential Responsibilities:

• Upholds Kaiser Permanentes Policies and Procedures, Principles of Responsibilities and applicable state, federal and local laws. The Financial Counselor II performs all duties currently performed by the Financial Counselor I and determines and approves Medical Financial Assistance and payment arrangements, provides reports to management, provides functional guidance to support the staff and completes Third Party insurance claims forms. If patient is determined to be indigent, assists patient with application for Medical Financial Assistance (MFAP) (members and non-members). Completes MFAP screens to track approval, denial, extension, etc. Determine patients ability to pay and make payment arrangements; identify the patient as medically indigent and refers patient to social services and/or other internal and external agencies as appropriate. Identify an alternate payer linkages or potential TPL or Workers Compensation cases; refer as appropriate. Verifies coverage on potential COB (members) cases by calling insurance carriers. Assists with collection of co-pays, Medi-Cal SOC, Conversion dues, non-member deposits, etc. Verifies eligibility for KP Membership through government programs using on-line systems (Medi-Cal, Medicare, transition plan, etc.). Verify pre-authorization for services from insurance carriers for outpatient and inpatient. Verify billing addresses for both hospital and professional services. Places telephone call to the appropriate departments (CSC, Sales and Marketing etc.) in cases where group eligibility is not updated or potential insurance fraud issues. Ensures that all documentation is complete and obtains missing or needed information including requesting charts. Establishes and maintains courteous, cooperative relations with the public, patients, and other personnel. Determine eligible coverage and add to patient account in correct filing order. Terminate any ineffective coverage. Assist with questionable eligibility and communicate as appropriate to clinical staff (pre-service) and coordinate with appropriate resources. Performs other related duties as required Informs care coordinators of non-member inpatient eligibility status (phone call) and keeps them updated. Interviews patients to obtain/determine payer source, financial and demographic information and obtains appropriate signatures. Determines if the service or item is covered under the MFAP guidelines. Complete and process Third Party insurance claim forms. Screen and direct correspondence to proper section or department. Provides reports to management as needed Faxes approval, denial, etc. letters to appropriate departments i.e. pharmacy, DME, etc. Provides functional guidance to the support staff and informs support staff and physicians on new and revised processes. Conduct periodic desk audits to identify backlogs and work queue issues. Provide feedback to DA as needed for training requirements and updates. Work designated HealthConnect work queues as assigned. May provide coverage for cashier as required. Assume other activities and responsibilities from time to time as directed.

Basic Qualifications:

Experience

Ability to use a computer keyboard to perform assigned duties. Knowledge of healthcare billing practices Excellent communication and interpersonal skills required Ability to work independently is required Ability to demonstrate knowledge of and to utilize Government Programs and alternate payer sources (Workers Compensation, TPL, COB, Commercial, etc.). Minimum of three (3) years of relevant experience in Health Care billing, collections or Financial Counseling or equivalent Demonstrated ability in patient registration, admissions, and billing practice required Experience in reviewing and analyzing financial information to assess ability to pay required.

Education

• High School Diploma/GED.

License, Certification, Registration

• N/A

Additional Requirements:

Preferred Qualifications:

• Certificate of completion of a course in Medical Terminology or required within 6 months of employment.

Notes:

• This is an on call position, days and hours may vary.

COMPANY: KAISER

TITLE: Financial Counselor II (PBS)

LOCATION: Downey, California

REQNUMBER: 1454624

External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.