Financial Counselor

Financial Counselor

This job exists to ensure that all patients membership status / alternative payor information is accurately identified and documented. Under indirect supervision, provides financial counsel to patients in a personal interview regarding payor sources and / or health plan benefit. It will accomplish the following revenue enhancing and member service functions. Increase revenue through accurate and timely identification of membership status / alternative payors. Counsel patients on payment alternatives. Resolve any member / patient disputes regarding eligibility for service.

Essential Responsibilities :

Confidentially probes patients who have been referred by staff such as inpatients / outpatient registration, department administrators, physicians, nursing, utilization management, and social workers about the nature of their problems as they may concern the ability to have services covered by an alternate payor (Non-member, Coordination of Benefits, Third Party Liability, Workers Compensation) or issues dealing with membership. If the patient is determined to be ineligible, uses independent judgment to identify an alternate payor or identify the patient as medical indigent. Uses knowledge of Workers Compensation, Commercial Insurance Plans, Third Party liability, outside agencies, and governmental regulations for government programs; patient interview & observation; analysis of financial data; and physicians notes in order to accurately identify an alternate payor. Skillfully probes patients about their financial status, counsels & make arrangements for direct payment, status as an indigent, potential enrollment in a government sponsored program, or direct billing to patient. If the patient is determined to be indigent & not be able to qualify for any governmental program, completes a KP medical Financial Assistance application & based on analysis of patients financial information, approved medical; Financial Assistance up to $2,000 value or recommended approval to supervisor when amount exceeds $2,000. Determines patients ability to pay based on analysis of patients financial information & negotiates & approved payment arrangements based on patients financial status. Provides functional guidance to the support staff & trains support staff & physicians on new / revised process. Acts as a patient / member advocate & uses knowledge of external & internal social service agencies to accurately refer patients to social services. Retrospectively reviews diagnosis & treatment records to identify potential Third Party Liability & Workers Compensation cases. Refers identified cases to the Billing Department. Screens for potential eligibility for KP membership through Government Programs (Medi-Cal, Medicare, transition Plan, etc.) & refers to Member Services. Obtains pre-authorization for services from employers or other insurance carriers. Coordinates & collects conversion dues for KP. Checks patient information against update eligibility using on-line systems. Places telephone calls to appropriate departments (Membership Accounting, Sales & Marketing, etc.) Ensures that all reviewed documentation in the billable jacket or on the superbill is complete & obtains any missing or needed information. Promotes, ensures, & improves customer service to internal / external customers by demonstrating skills which are consistent with the organizations philosophy of providing extraordinary customer relations & quality service.

Basic Qualifications :

Experience : Minimum of 2 years relevant experience (health care billing, collections) sufficient to analyze financial information to determine / negotiate financial arrangements. Experience in reviewing & analyzing financial information to assess ability to pay required. Experience w / automated data bases of PC systems required. Knowledge of workers compensation coordination of benefits & third party liability rules & regulations. Medical terminology & knowledge of health care billing practices required. Knowledge of registration bill accounting & collections required. Able to use RMIS, CARG, KPDS, OPAS & ARRS

Notes :

Schedule to include all shifts, rotating weekends, holidays, and floating within the established seniority section.