Patient Financial Advisor

About the role

The Patient Financial Advisor is responsible for reviewing patient information, validating insurance and financial records, and managing patient accounts. This includes gathering and analyzing patient information, negotiating payment plans, and providing financial advice.

Responsibilities

• Reviews patient information provided by referring party and/or meets with patient/family member to complete all insurance and financial records or refers if there is a vendor designated to perform these responsibilities.
• Validates eligibility and benefits from insurance carriers for Emergency, Outpatient, Inpatient encounters prior to, during and post services, including, continued monitoring for eligibility, authorization of insurance and medical coverage on active patient accounts.
• Gathering and analyzing all patient information pertaining to financial resources and circumstances.
• Identifies commercial, self-pay or under insured account coverages and is responsible for following up with the patient/patients family to request payments, negotiates payment plans and, if necessary, to assure a Medicaid or financial assistance application is initiated.
• Notifies insurance carriers of intent to admit and initiates authorization for payment of stay.
• Advising and educating patients of their financial care responsibilities, related to current services.
• Understanding the work processes of Patient Access Representative with abilities to perform such that they are accountable to ensure complete and accurate patient admissions/registrations, according to organization policy and procedures and regulatory requirements.
• Identifying, receiving internal referrals for or requests from patients who may be at financial risk and/or require assistance to assure payment for current, pending, or prior medical services.
• Interviewing patients regarding possible workers compensation coverage, Coordination of Benefits and/or Third-Party Liability.
• Determining patients ability to pay based on an assessment of assets and liabilities and negotiates and approves payment arrangements based on patients financial status and counselors sound judgment according to policy.
• Providing patient liability information to and collecting from patients based on guidelines and/or systems provided by the department, including but not limited to: co-payments, deductibles, co-insurance, deposits, outstanding prior balances.
• Completing CMS regulatory forms with patient or representative based upon admission status, in partnership with Care Management. (IMM, MOON, Code 44).
• Informing and delivering of bill summary when financial class changes from a covered payor to a self-pay status. Including explanation of financial obligation going forward throughout the stay.
• Determining need to consult with Care Management personnel and physicians regarding status of patient admission/and insurance requirements and collaborates as needed.
• Collaborating with Patient Financial Services, Health Information Management, and Clinical Information Systems for regional requirements of patient information, service outcomes, and status of accounts.
• Absorbing and resolving complex problem accounts at the time of service. Patients may require intensive follow up with resolution prior to discharge.
• Documenting all activity pertaining to patients account in the Kaiser Permanente EMR (Electronic Medical Record) system of record (KP HealthConnect).
• Reviewing and following up on electronic reports for incomplete accounts, ensuring all required data fields for insurance verification, reporting and claims submission are accurately completed, to ensure a clean bill.
• Performing audits to determine the accuracy and completeness of the data collected.
• Maintaining records during system downtime and assist in recovery processes.
• Performing all or part of duties and responsibilities at the direction of department management based on appropriate needs of the department, and all other tasks and duties as assigned by supervisor.
• The Patient Financial Advisor works collaboratively with Hospital, Clinic, Emergency Department and Member Services personnel to create a customer friendly environment.
• Accommodates work schedule and shift flexibility according to department needs.
• Contributes to the success of the organization by participating in the organizational and customer service/employee relations action plan programs, keeping current on new developments within the Kaiser Permanente Organization.
• Maintains working knowledge of Fair Debt Collection Laws along with State and Federal rules and regulations for billing Medicaid, Medicare, Champus, etc.
• Performs other duties as needed or assigned.

Requirements

• Two (2) years of work experience including twelve (12) months of hospital, preauthorization, financial counseling, insurance company or billing experience required or graduate of a health vocational program (12-18-month duration.) required.
• Three (3) years experience in dealing with the public in a customer service role.
• High School Diploma or General Education Development (GED) required.
• One (1) year post high school business or college course work.
• Healthcare Access Associate Certificate within 6 months of hire from National Association of Healthcare Access Management
• Basic Life Support required at hire
• Medical Terminology Certification
• Hospital Patient Registration experience.
• Basic knowledge and use of computer and computer keyboard.
• Able to pass PC skills assessment and keyboarding test [a rate of 6,000 keystrokes/hour is required to pass].
• Proficient in medical terminology.
• Able to pass KP standardized test.
• Must be able to apply benefit circumstances to fee schedule quotation to determine member/patient cost share obligation.
• Able to pass fee/benefit test.
• Capable of making decisions and working independently to accomplish all responsibilities, as well as maintain an in-depth understanding of job duties and operational changes where financial counseling decisions have significant financial and medical implications.
• Demonstrated knowledge of the admitting and registration processes and requirements. Effective interpersonal and communications skills. Knowledgeable regarding the impact Utilization Review, Discharge Planning, Admissions, and other related departments have on reimbursement.
• Demonstrated ability to understand and interpret benefit coverage information, including KP Plans, Medicaid, Medicare, Commercial coverages, and other insurance plans.
• Cash handling experience.
• Able to work independently under limited supervision, take initiative, deal effectively with constant change, and willingly accept responsibility.
• Computer experience and training in Windows and MS Word.
• Three (3) years as a Patient Access Representative II or Pre-Registration Representative, or equivalent, in a 24/7 hospital environment.
• Two years of higher education preferred.

Qualifications

• Two (2) years of work experience including twelve (12) months of hospital, preauthorization, financial counseling, insurance company or billing experience required or graduate of a health vocational program (12-18-month duration.) required.
• Three (3) years experience in dealing with the public in a customer service role.
• High School Diploma or General Education Development (GED) required.
• One (1) year post high school business or college course work.
• Healthcare Access Associate Certificate within 6 months of hire from National Association of Healthcare Access Management
• Basic Life Support required at hire
• Medical Terminology Certification
• Hospital Patient Registration experience.
• Basic knowledge and use of computer and computer keyboard.
• Able to pass PC skills assessment and keyboarding test [a rate of 6,000 keystrokes/hour is required to pass].
• Proficient in medical terminology.
• Able to pass KP standardized test.
• Must be able to apply benefit circumstances to fee schedule quotation to determine member/patient cost share obligation.
• Able to pass fee/benefit test.
• Capable of making decisions and working independently to accomplish all responsibilities, as well as maintain an in-depth understanding of job duties and operational changes where financial counseling decisions have significant financial and medical implications.
• Demonstrated knowledge of the admitting and registration processes and requirements. Effective interpersonal and communications skills. Knowledgeable regarding the impact Utilization Review, Discharge Planning, Admissions, and other related departments have on reimbursement.
• Demonstrated ability to understand and interpret benefit coverage information, including KP Plans, Medicaid, Medicare, Commercial coverages, and other insurance plans.
• Cash handling experience.
• Able to work independently under limited supervision, take initiative, deal effectively with constant change, and willingly accept responsibility.
• Computer experience and training in Windows and MS Word.
• Three (3) years as a Patient Access Representative II or Pre-Registration Representative, or equivalent, in a 24/7 hospital environment.
• Two years of higher education preferred.

Skills

• Knowledge of medical terminology, diagnostic related groupings (DRGs/MSDRGs), diagnosis code (ICD-9-CM) and common procedure terminology (CPT 4/APC) codes to determine benefits and estimate service cost.
• Knowledge of other pertinent federal and state health care regulations such as HIPAA and EMTALA, CMS, TJC, etc.
• Knowledge of other pertinent federal and state health care regulations such as HIPAA and EMTALA, CMS, TJC, etc.
• Knowledge of other pertinent federal and state health care regulations such as HIPAA and EMTALA, CMS, TJC, etc.
• Knowledge of other pertinent federal and state health care regulations such as HIPAA and EMTALA, CMS, TJC, etc.
• Knowledge of other pertinent federal and state health care regulations such as HIPAA and EMTALA, CMS, TJC, etc.
• Knowledge of other pertinent federal and state health care regulations such as HIPAA and EMTALA, CMS, TJC, etc.
• Knowledge of other pertinent federal and state health care regulations such as HIPAA and EMTALA, CMS, TJC, etc.
• Knowledge of other pertinent federal and state health care regulations such as HIPAA and EMTALA, CMS, TJC, etc.
• Knowledge of other pertinent federal and state health care regulations such as HIPAA and EMTALA, CMS, TJC, etc.
• Knowledge of other pertinent federal and state health care regulations such as HIPAA and EMTALA, CMS, TJC, etc.
• Knowledge of other pertinent federal and state health care regulations such as HIPAA and EMTALA, CMS, TJC, etc.
• Knowledge of other pertinent federal and state health care regulations such as HIPAA and EMTALA, CMS, TJC, etc.
• Knowledge of other pertinent federal and state health care regulations such as HIPAA and EMTALA, CMS, TJC, etc.
• Knowledge of other pertinent federal and state health care regulations such as HIPAA and EMTALA, CMS, TJC, etc.
• Knowledge of other pertinent federal and state health care regulations such as HIPAA and EMTALA, CMS, TJC, etc.
• Knowledge of other pertinent federal and state health care regulations such as HIPAA and EMTALA, CMS, TJC, etc.
• Knowledge of other pertinent federal and state health care regulations such as HIPAA and EMTALA, CMS, TJC, etc.
• Knowledge of other pertinent federal and state health care regulations such as HIPAA and EMTALA, CMS, TJC, etc.
• Knowledge of other pertinent federal and state health care regulations such as HIPAA and EMTALA, CMS, TJC, etc.
• Knowledge of other pertinent federal and state health care regulations such as HIPAA and EMTALA, CMS, TJC, etc.
• Knowledge of other pertinent federal and state health care regulations such as HIPAA and EMTALA, CMS, TJC, etc.
• Knowledge of other pertinent federal and state health care regulations such as HIPAA and EMTALA, CMS, TJC, etc.