Financial Counselor

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 health plan benefit.

Essential Responsibilities

• 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.
• 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.
• 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

• 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.
• Knowledge of workers compensation coordination of benefits & third party liability rules & regulations.
• Mandatory Medical terminology & knowledge of health care billing practices.
• Mandatory Knowledge of registration bill accounting & collections.
• Able to use RMIS, CARG, KPDS, OPAS & ARRS.

Additional Requirements

• N/A

Preferred Qualifications

• N/A

Notes

This is a temporary position for approximately 3-6 months. Schedule to include all shifts, rotating weekends, holidays, and floating within the established seniority section.

Primary Location

Riverside, California, 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

Employee Status

Temporary

Employee Group/Union Affiliation

B05|USW|Local 7600

Job Level

Individual Contributor

Department

Riverside Med Center - Admitting - 0801

Pay Range

$29.5 - $32.55 / hour