Kaiser Permanente Northwest · 3 months ago
Patient Financial Advisor
Hillsboro, OR
Contract
Onsite
Mid Level
3+ years expKaiser Permanente Northwest is seeking a Patient Financial Advisor responsible for determining patient financial liability and assisting with financial assessments. The role involves interpreting regulatory requirements, negotiating payment arrangements, and ensuring effective communication with patients regarding their financial obligations.
Hospital & Health Care
Responsibilities
Reviews patient information provided by referring party and/or meets with patient/family member to complete all insurance and financial records or refers if there is a vendor designated to perform these responsibilities
Validates eligibility and benefits from insurance carriers for Emergency, Outpatient, Inpatient encounters prior to, during and post services, including, continued monitoring for eligibility, authorization of insurance and medical coverage on active patient accounts
Gathering and analyzing all patient information pertaining to financial resources and circumstances
Identifies commercial, self-pay or under insured account coverages and is responsible for following up with the patient/patients family to request payments, negotiates payment plans and, if necessary, to assure a Medicaid or financial assistance application is initiated
Notifies insurance carriers of intent to admit and initiates authorization for payment of stay
Advising and educating patients of their financial care responsibilities, related to current services
Understands the work processes of Patient Access Representative with abilities to perform such that they are accountable to ensure complete and accurate patient admissions/registrations, according to organization policy and procedures and regulatory requirements
Identifies, receives internal referrals for or requests from patients who may be at financial risk and/or require assistance to assure payment for current, pending, or prior medical services
Interviewing patients regarding possible workers compensation coverage, Coordination of Benefits and/or Third-Party Liability
Determines patients ability to pay based on an assessment of assets and liabilities and negotiates and approves payment arrangements based on patients financial status and counselors sound judgment according to policy
Provides patient liability information to and collects from patients based on guidelines and/or systems provided by the department, including but not limited to:
Co-payments
Deductibles
Co-insurance
Deposits
Outstanding prior balances
Knowledge of medical terminology, diagnostic related groupings (DRGs/MSDRGs), diagnosis code (ICD-9-CM) and common procedure terminology (CPT 4/APC) codes to determine benefits and estimate service cost
Knowledge of other pertinent federal and state health care regulations such as HIPAA and EMTALA, CMS, TJC, etc
Analyzes patients financial information and provides financial screening advice to patients, when appropriate, regarding payment options and scheduling and location alternatives
Assisting patients with understanding their benefits when a cost-share is owed
Complete CMS regulatory forms with patient or representative based upon admission status, in partnership with Care Management. (IMM, MOON, Code 44)
Inform and delivery of bill summary when financial class changes from a covered payor to a self-pay status. Including explanation of financial obligation going forward throughout the stay
Determines need to consult with Care Management personnel and physicians regarding status of patient admission/and insurance requirements and collaborates as needed
Collaborates with Patient Financial Services, Health Information Management, and Clinical Information Systems for regional requirements of patient information, service outcomes, and status of accounts
Assists financial assistance vendors/department, when in compliance with the vendor contract, to assure completion of any paperwork that is necessary to obtain payment from appropriate payors, workers compensation case or third-party liability, or works directly with the patient to assist, if there is not a designated vendor
Follows-up with patient to resolve any difficulties, completing required paperwork, as appropriate
Researches and resolves complex problem accounts at the time of service. Patients may require intensive follow up with resolution prior to discharge
Documents all activity pertaining to patients account in the Kaiser Permanente EMR (Electronic Medical Record) system of record (KP HealthConnect)
Reviews and follow up on electronic reports for incomplete accounts, ensuring all required data fields for insurance verification, reporting and claims submission are accurately completed, to ensure a clean bill
Perform audits to determine the accuracy and completeness of the data collected on the Ensures patient information and contact is handled confidentially and the patient is treated with dignity, regardless of financial circumstances patient account at time of service
Collecting statistical data and prepare reports, as needed
Responsible for maintaining records during system downtime and assist in recovery processes
Performing all or part of duties and responsibilities at the direction of department management based on appropriate needs of the department, and all other tasks and duties as assigned by supervisor
The Patient Financial Advisor works collaboratively with Hospital, Clinic, Emergency Department and Member Services personnel to create a customer friendly environment
Accommodates work schedule and shift flexibility according to department needs
Contributes to the success of the organization by participating in the organizational and customer service/employee relations action plan programs, keeping current on new developments within the Kaiser Permanente Organization
Maintains working knowledge of Fair Debt Collection Laws along with State and Federal rules and regulations for billing Medicaid, Medicare, Champus, etc
Performs other duties as needed or assigned
Qualification
Required
Two (2) years of work experience including twelve (12) months of hospital, preauthorization, financial counseling, insurance company or billing experience required or graduate of a health vocational program (12-18-month duration.) required
Three (3) years experience in dealing with the public in a customer service role
High School Diploma or General Education Development (GED) required
One (1) year post high school business or college course work
Healthcare Access Associate Certificate within 6 months of hire from National Association of Healthcare Access Management
Basic Life Support required at hire
Medical Terminology Certification
Hospital Patient Registration experience
Basic knowledge and use of computer and computer keyboard
Able to pass PC skills assessment and keyboarding test [a rate of 6,000 keystrokes/hour is required to pass]
Proficient in medical terminology
Able to pass KP standardized test
Must be able to apply benefit circumstances to fee schedule quotation to determine member/patient cost share obligation
Able to pass fee/benefit test
Capable of making decisions and working independently to accomplish all responsibilities, as well as maintain an in-depth understanding of job duties and operational changes where financial counseling decisions have significant financial and medical implications
Demonstrated knowledge of the admitting and registration processes and requirements
Effective interpersonal and communications skills
Knowledgeable regarding the impact Utilization Review, Discharge Planning, Admissions, and other related departments have on reimbursement
Demonstrated ability to understand and interpret benefit coverage information, including KP Plans, Medicaid, Medicare, Commercial coverages, and other insurance plans
Cash handling experience
Ability to work independently under limited supervision, take initiative, deal effectively with constant change, and willingly accept responsibility
Computer experience and training in Windows and MS Word
Preferred
Three (3) years as a Patient Access Representative II or Pre-Registration Representative, or equivalent, in a 24/7 hospital environment
Two years of higher education preferred
Company
Kaiser Permanente Northwest
Kaiser Permanente is committed to helping shape the future of health care.
10001+ employees
Funding
Current Stage
Late StageLeadership Team
Karen Miles
Chief Operating Officer
Wendy Watson
Chief Operating Officer
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