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Kaiser Permanente · 23 hours ago

Financial Counselor

Moreno Valley, CA

Full-time

Onsite

Mid Level

3+ years exp

Kaiser Permanente is seeking a Financial Counselor to ensure accurate identification and documentation of patient membership status and to resolve patient liabilities at the point of service. The role involves providing financial counsel to patients, negotiating payment arrangements, and advocating for patients' needs while enhancing revenue through efficient billing practices.

Health CareHospitalMental HealthNon ProfitPersonal Health

Comp. & Benefits

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 payer (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 payer 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 and observation; analysis of financial data; and physicians notes in order to accurately identify an alternate payer

Skillfully probes patients about their financial status, counsels and 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 and not be able to qualify for any governmental program, completes a Kaiser Permanente medical Financial Assistance application and 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 and negotiates and approved payment arrangements based on patients financial status

Provides functional guidance to the support staff and trains support staff and physicians on new/revised process

Acts as a patient/member advocate and uses knowledge of external and internal social service agencies to accurately refer patients to social services

Retrospectively reviews diagnosis and treatment records to identify potential Third Party Liability and Workers Compensation cases

Refers identified cases to the Billing Department

Screens for potential eligibility for Kaiser Permanente membership through Government Programs (Medi-Cal, Medicare, transition Plan, etc.) and refers to Member Services

Obtains pre-authorization for services from employers or other insurance carriers

Coordinates and collects conversion dues for Kaiser Permanente

Checks patient information against update eligibility using on-line systems

Places telephone calls to appropriate departments (Membership Accounting, Sales and Marketing, etc.)

Ensures that all reviewed documentation in the billable jacket or on the superbill is complete and obtains any missing or needed information

Promotes, ensures, and improves customer service to internal/external customers by demonstrating skills which are consistent with the organizations philosophy of providing extraordinary customer relations and quality service

Qualification

Healthcare billingFinancial analysisMedical terminologyWorkers compensation knowledgeThird party liability knowledgeAutomated database systemsCustomer service skillsTraining skillsNegotiation skills

Required

Minimum of 3-4 years relevant experience (Healthcare billing, collections) sufficient to analyze financial information to determine/negotiate financial arrangements

Experience in reviewing and analyzing financial information to assess ability to pay required

Experience with automated data base of PC systems required

Knowledge of workers compensation coordination of benefits and third party liability rules and regulations

Medical terminology and knowledge of healthcare billing practices required

Knowledge of registration bill accounting and collections required

Able to use RMIS, CARG, KPDS, OPAS, and ARRS

May be required to travel to multiple sites