Financial Counselor

This job exists to ensure that all patients membership status/alternative payer information is accurately identified and documented, and (2) Collect or otherwise resolve all patient liabilities due at point-of-service, including insurance and government program co-payments, deductibles, shares of cost, and other amounts due at time of service.  Under indirect supervision, provides financial counsel to patients in a personal interview regarding payer sources and/or heath plan benefit.  It will accomplish the following revenue enhancing and member service functions:  - Increase revenue through accurate and timely identification of membership status/alternative payers - Counsel patients on payment alternatives - Resolve any member/patient disputes regarding eligibility for service.

• 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.