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Kaiser Permanente Careers

Accounting, Actuarial & Finance

Support the Bottom Line — and the Big Picture

Create the financial strategies that affect our patients, medical centers, and future. On this team, you'll provide the strategy recommendations that drive operational and process improvement, as well as face challenging opportunities to influence the future of health care.

Financial Counselor

Location: San Diego, CA Additional Locations:

La Mesa Administration Building 8010 Parkway Dr., 8010 Parkway Dr., La Mesa,California, 91941
San Diego Medical Center 9455 Clairemont Mesa Blvd, 9455 Clairemont Mesa Blvd., San Diego,California, 92123
Job Number: 874291 Date posted: 03/26/2020
This job exists to ensure that all patients' membership status & alternative payer information is accurately identified & documented. Under indirect supervision, provides financial counsel to patients in a personal interview regarding available payer sources and/or health plan coverage. It will accomplish & perform the following important revenue enhancing, member service & organizational compliance functions:Increase revenue through accurate & timely identification of membership status & alternative payers. Enable service representatives to focus on patient service. Verify eligibility for services & counsel patient's on payment alternatives as needed. Follow KP & departmental established guidelines for all lines of business sand MFA Program. Follow established code of conduct for business processes & HIPPA guidelines in compliance w/ all applicable State & Federal regulations. Demonstrate ability to exercise diligence, care & integrity in performance of my duties. 

Essential Functions:
- Confidentially interviews patients who have been referred by service representatives & other internal personnel regarding alternate payer(s) (Non-members, Coordination of Benefits, Third Party Liability, Workers' Compensation) and/or issues regarding eligibility status
- Uses independent judgment to identify alternate payer(s) or identify the patient as medically indigent
- Requires knowledge of Workers' Compensation, Commercial Insurance Plans, Third Party Liability, & governmental regulations for government programs.
- Financial Counselor will investigate potential eligibility for KP membership through available Government Programs (MediCal, MediCare, Transition Plan, etc) & refer for enrollment as appropriate
- If the patient is determined to be indigent & has no alternate payer(s), completes a Medical Financial Assistance application & based on an analysis of patient's financial information, recommends approval to Supervisor
- May review CPR's, and/or clinical documents to identify potential Third Party Liability and/or Workers' Compensation   cases
- Obtains pre-authorization from or conducts notification of treatment to employers or other insurance carriers
- Eligibility status is verified using on-line eligibility systems
- Telephone calls may be placed appropriate departments (Membership Accounting, Sales & Marketing, etc) in cases where group eligibility is not regularly updated
- Reviews documentation contained in billable jacket/superbill for completeness
- Researches, investigates, & obtains any missing or needed information/documentation prior to being sent to the Business Services Department
- KP Service Standards:
- Follows established service standards as set forth in LMP ABC's
- That is, Take Initiative, Take Responsibility, Take Care & Take Pride
- Demonstrate compliance in all above 4 areas
- Example: make a positive first impression, protect patient privacy & confidentiality, assume ownership, resolve conflict, show respect, maintain your environment & support your team
- Equipment Utilized: Personal Computer, Mainframe CRT, Adding Machine, Fax Machine, Photocopier, Telephone Equipment, Typewriter, Point of Service Device
- Assume other activities & responsibilities from time to time as directed
Basic Qualifications:
- 3 to 4 years of relevant experience such as Health Care Billing, Collections or Financial Counseling demonstrates the ability to analyze financial information to determine & negotiate the appropriate financial/billing arrangements
- Experience in reviewing & analyzing financial information to assess ability to pay
- Experience in direct member/patient contact
- Experience w/ automated data bases CRT or PC systems
- B.S. in business, communications preferred
- Knowledge of Workers' Compensation, Coordination of Benefits, & Third Party Liability rules & regulations
- Knowledge of government payer sources such as Medicare, MediCal, etc
- Knowledge of outside agency sources such as Medicaid, victims of Violent Crime, California Children's Society, Department of Social Services or county agency programs - able to pass standardized test
- Knowledge of Registration (inpatient/outpatient), health care Billing, Member Service, Membership Accounting or Collection
- Demonstrated medical terminology & knowledge of ICD9 diagnostic coding &CPT procedural coding is required - able to pass standardized test
- Ability to use KPDS, OPAS/CARG, ARRS, & FCMS is preferred
- Ability to interpret insurance requirements & knowledge of health care billing practices
- Ability to conduct assertive professional & courteous patient financial interviews
- Must have reliable transportation - will be required to travel by car to medical office buildings as needed to accommodate operational needs or to conduct patient interviews
- Must provide proof of insurance for vehicle
Primary Location: California,San Diego,San Diego Medical Center 4647 Zion Ave. Scheduled Weekly Hours: 0 Shift: Variable Workdays: Mon, Tue, Wed, Thu, Fri, Sat, Sun Working Hours Start: Varies Working Hours End: Varies Job Schedule: Call-in/On-Call Job Type: Standard Employee Status: Regular Employee Group/Union Affiliation: OPEIU - Local 30 Job Level: Individual Contributor Job Category: Accounting, Finance and Actuarial Services Specialty: Finance Department: Admitting Travel: Yes, 5 % of the Time Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status.

External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with federal and state laws, as well as applicable local ordinances, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances.

About Accounting, Finance, & Actuarial Careers

Accounting Careers

Members of our accounting team support corporate projects and lend insight to areas such as financial reporting, tax planning and preparation, and audit management. This team also includes our audit professionals, who partner with financial and operational groups across the organization to analyze budgets and streamline procedures.

Finance Careers

Supporting critical business functions such as financial services, national Medicare finance, strategic planning, auditing, and corporate finance, our finance professionals develop the strategies that enable us to meet our financial goals.

Actuarial Careers

Applying probability and statistics to the practical problems of insurance, our actuarial team performs a variety of duties, including calculating the cost of premiums and policy values, preparing statistical studies, and forecasting financial results.

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