Patient Financial Advisor (PFA)

Department: Patient Accounting | Reports to: Director of Patient Financial Services | Type: Full Time-Non Exempt

About the Role

The Patient Financial Advisor (PFA) offers financial advice and assistance to patients regarding medical bills. The PFA serves as the liaison between patients and their insurance companies, coordinating payments and answering questions from both parties. The PFA ensures appropriate reimbursement resources are in place for services provided. If patients are registered without insurance coverage, the PFA actively screens all inpatients and outpatients for other insurance options.

Responsibilities

• Verification of demographic and insurance information, including third-party insurances.
• Accurate and timely determination of payer and patient liability, including notifications and initial authorizations required.
• Validate that required authorizations/notifications are obtained for hospital stays and outpatient services.
• Adhere to government and non-government program requirements.
• Effectively communicate with patients regarding benefits, program requirements, personal payment liabilities, and options for care, while protecting the financial interest of Chinese Hospital Association.
• Provide information on self-pay discounts when no other options are available and set up payment arrangements as needed.
• Discuss patient financial liability for services rendered and collect payments as applicable.
• Assist eligible patients in applying for Hospital Presumptive Eligibility (HPE), Full Scope Medi-Cal, and referrals to other insurance coverages if not qualifying for Medi-Cal.
• Apply Treat Authorization Requirement (TAR) for all eligible accounts.
• Review all assigned DNFB (Discharged Not Final Billed) for appropriate billing actions.
• Communicate with patients and insurance companies via phone, documenting and reporting payment information.
• Advise patients and/or family members and Case Management on insurance benefits, exclusions, and financial obligations.
• Determine primary coverage when multiple insurances are involved, verify insurance eligibility, collect payments, and arrange payment plans if necessary.
• Educate patients about payment options and financial assistance.
• Negotiate and strategize patient payments.
• Update patient accounts and balances.
• Review and process payments from patients and insurance companies.
• Work with pharmacies and pharmacy insurance programs to ensure prescribed medications are covered.
• Provide proper documentation to insurance companies to ensure coverage.
• Communicate with CHA’s third-party billing to ensure claims are handled efficiently.
• Ensure all Infusion accounts are pre-admitted, registered, and financially resourced.
• Work with front registration during business hours to capture uninsured/underinsured patients; if during off-hours, reach out to patients the next business day.
• Follow Hospital and Department policies and procedures, including Administrative Manual, Environment of Care, Human Resources, Infection Control, Corporate Compliance, and Code of Ethics.
• Attend, actively participate in, and complete in-services, training classes, mandatory classes, seminars/workshops, staff meetings, exercises, and drills.
• Provide excellent customer service, showing compassion to all patients, visitors, and co-workers.
• Keep manager and team informed of progress, problems, developments, and plans.
• Interact positively with co-workers and others.
• Accept and perform other duties as assigned.

Qualifications

• Required: Medical Office Experience.
• Required: Computer proficiency (EMR knowledge a plus).
• Required: Effective communication skills to work with patients, families, doctors, and insurance providers.
• Required: Strong customer service skills.
• Required: Ability to effectively present information, both verbally and in writing.
• Required: Ability to take initiative, adapt to changing priorities, and work independently.
• Required: Strong time management and prioritization skills.
• Required: Knowledge of medical terminology, including medications.
• Preferred: High School Diploma or equivalent.
• Preferred: Bilingual in Chinese (Cantonese and/or Mandarin) or Spanish.
• Preferred: Knowledge of community resources and cultural sensitivity.

Physical Requirements

• Regularly required to sit, stand, walk, talk, and/or listen.
• Use hands for computer work, writing reports, equipment setup/cleaning/storage, and clerical support.
• Frequent phone use.
• Good vision to read schedules and enter accurate data.
• Good general health and emotional stability to carry out duties.
• Able to lift up to 30 pounds.
• Use proper body mechanics when handling equipment.
• Standing, walking, and moving 50% of the day.

Compliance Requirements

Complies with Chinese Hospital Compliance Handbook, including Code of Ethics and all statutes, regulations, and guidelines applicable to federal and state programs. Responsibilities include following guidelines and reporting suspected violations of any statute, regulations, agreements, or guidelines applicable to all healthcare programs.

Pay

Starting at $31.91-$39.26 per hour. The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, specialty, and training.