Financial Counselor
Primary Location Riverside, California
Worker Location Onsite
Facility Riverside Medical Center/Medical Offices 1
Job Number 1352653 Date posted 05/15/2025
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Description:
This job exists to ensure that all patients membership status/alternative payor information is accurately identified & documented. Under indirect supervision, provides financial counsel to patients in a personal interview regarding payor sources and/or heath plan benefit. It will accomplish the following revenue enhancing & member service functions. Increase revenue through accurate & timely identification of membership status/alternative payors. Counsel patients on payment alternatives. Resolve any member/patient disputes regarding eligibility for service.
This description is for recruitment posting purposes only. It has not received full HR review and approval.
- Confidentially probes patients who have been referred by staff such as inpatients/outpatient registration, department administrators, physicians, nursing, utilization management & 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 w/ 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, & governmental regulations for government programs; patient interview & observation; analysis of financial data; & 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 w/ the organizations philosophy of providing extraordinary customer relations & quality service.
Job Summary:
This job exists to ensure that all patients membership status/alternative payor information is accurately identified & documented. Under indirect supervision, provides financial counsel to patients in a personal interview regarding payor sources and/or heath plan benefit. It will accomplish the following revenue enhancing & member service functions. Increase revenue through accurate & timely identification of membership status/alternative payors. Counsel patients on payment alternatives. Resolve any member/patient disputes regarding eligibility for service.
Essential Responsibilities:
This description is for recruitment posting purposes only. It has not received full HR review and approval.
- Confidentially probes patients who have been referred by staff such as inpatients/outpatient registration, department administrators, physicians, nursing, utilization management & 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 w/ 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, & governmental regulations for government programs; patient interview & observation; analysis of financial data; & 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 w/ 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
Education
- N/A
License, Certification, Registration
- N/A
Additional Requirements:
- N/A
Preferred Qualifications:
- N/A
Notes:
• Will be included in weekend rotation.
• May include consecutive weekend coverage as operationally needed.
• Will work holidays.
Primary Location: California,Riverside,Riverside Medical Center/Medical Offices 1
Scheduled Weekly Hours: 20
Shift: Variable
Workdays: Mon, Tue, Wed, Thu, Fri, Sat, Sun
Working Hours Start: 12:01 AM
Working Hours End: 11:59 PM
Job Schedule: Call-in/On-Call
Job Type: Standard
Worker Location: Onsite
Employee Status: Regular
Employee Group/Union Affiliation: B05|USW|Local 7600
Job Level: Individual Contributor
Department: Riverside Med Center - Admitting - 0801
Pay Range: $27.7 - $30.56 / hour
The ranges posted above reflect the location in the job posting. The salary range may vary if you reside in a different location or state than the location posted.
Travel: Yes, 5 % of the Time
On-site: Work location is on-site (KP designated office, medical office building or hospital).
Worker location must align with Kaiser Permanente's Authorized States policy.
At Kaiser Permanente, equity, inclusion and diversity are inextricably linked to our mission, and we aim to make it a part of everything we do. We know that having a diverse and inclusive workforce makes Kaiser Permanente a better place to receive health care, a more supportive partner in our communities we serve, and a more fulfilling place to work. Working at Kaiser Permanente means that you agree to and abide by our commitment to equity and our expectation that we all work together to create an inclusive work environment focused on a sense of belonging and wellbeing.
Kaiser Permanente is an equal opportunity employer committed to fair, respectful, and inclusive workplaces. Applicants will be considered for employment without regard to race, religion, sex, age, national origin, disability, veteran status, or any other protected characteristic or status.
For jobs where work will be performed in unincorporated LA County, the employer provides the following statement in accordance with the Los Angeles County Fair Chance Ordinance. Criminal history may have a direct, adverse, and negative relationship on the following job duties, potentially resulting in the withdrawal of the conditional offer of employment:
Consistently supports compliance and the Principles of Responsibility (Kaiser Permanente's Code of Conduct) by maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting non-compliance, and adhering to applicable federal, state, and local laws and regulations, accreditation, and licensure requirements (where applicable), and Kaiser Permanente's policies and procedures.
Models and reinforces ethical behavior in self and others in accordance with the Principles of Responsibility, adheres to organizational policies and guidelines; supports compliance initiatives; maintains confidences; admits mistakes; conducts business with honesty, shows consistency in words and actions; follows through on commitments.
Job duties with at least occasional or possible access to: (1) patients, the general public, or other employees; (2) confidential protected health information and other confidential KP information (including employee, proprietary, financial or trade secret information); (3) KP property and assets, for example, electronic assets, medical instruments, or devices; (4) controlled substances regulated by federal law or potentially subject to diversion.
Submit Interest
Kaiser Permanente is an equal opportunity employer committed to fair, respectful, and inclusive workplaces. Applicants will be considered for employment without regard to race, religion, sex, age, national origin, disability, veteran status, or any other protected characteristic or status.
For jobs where work will be performed in unincorporated LA County, the employer provides the following statement in accordance with the Los Angeles County Fair Chance Ordinance. Criminal history may have a direct, adverse, and negative relationship on the following job duties, potentially resulting in the withdrawal of the conditional offer of employment:
