Financial Counselor Representative- MMMC

Under indirect supervision, advises patients and/or family members of health plan benefits and exclusions and financial obligations; collects and verifies membership and other insurance eligibility applicable to services rendered; collects payments, deposits and/or arranges for payment plans as appropriate to services; processes applications for medical financial assistance (MFA) and/or other applications as appropriate; documents interview, payment arrangements, and all other pertinent information in KP HealthConnect; assists customers with complaints or inquiries regarding bills and/or charges including, but not limited to, explanation of charges, Kaiser Permanente payment policy, and health plan benefits and exclusions.

• Advises patients and/or family members of health plan benefits and exclusions and financial obligations; determines primary coverage when multiple  insurances are involved;  collects and verifies membership and other insurance eligibility applicable to services rendered; collects payments, deposits and/or arranges for payment plans as appropriate to services; obtains signed acknowledgement of financial responsibility; interviews patients as referred;  obtains and completes information for MSP, Coordination of Benefits (COB) and other regulatory forms as required; collaborates with Patient Accounting collections staff to monitor patients account according to established criteria.


• Contacts physician offices or other facilities to obtain necessary information.


• Documents pertinent information and financial counseling activities in accordance with department and/or regulatory policies and/or procedures;  communicates financial payment issues  to appropriate representative in patient care area  for non-urgent or emergent care to determine postponement and/or cancellation of services; informs supervisor of potential postponements/ cancellations of elective or non-urgent care.


• Proactively contacts patients to pre-register them for selected procedures and/or those patients with selected insurance coverages; advises patients of estimated cost share; arranges for deposits/pre-payment prior to procedure in accordance with department protocols and procedures.


• As needed, completes appropriate applications for patients seeking Medicaid and/or SSDI coverage; When applicable, obtains authorizations for and processes appropriate forms to secure payments directly to Kaiser; advises Medicaid patients of cost obligations; generates initial cost share statements to patients.


• Completes admission requirements, including all pertinent required documents but not limited to third party coverage, personal identification cards, authorizations/consents and signatures, consents for release of medical information; ensures payer pre-certification/medical review requirements are met.


• Processes applications for medical financial assistance (MFA) and/or other applications as appropriate; determines patients eligibility by interviewing and collecting personal financial information; identifies appropriate hospital, public and/or private financial assistance programs; collaborates and/or refers to Medical Social Services, QUEST,  Utilization Management and/or external agencies as needed; obtains necessary authorizations required for services; reinforces established payment guidelines as needed; documents interview, payment arrangements, and all other pertinent information in KP HealthConnect; follows up patients as appropriate.


• Calculates and determines if member has met co-pay maximum; issues co-pay maximum card as needed; requests refunds when appropriate.


• Advises clinic and/or hospital staff regarding processing of  non-KPHC charges; provides information regarding professional fees, charges for supplies, and other tools to support operations; directs staff to appropriate tools and/or department for problem resolution; answers patient inquires as needed.


• Assists customers with complaints or inquiries regarding bills and/or charges including, but not limited to, explanation of charges, Kaiser Permanente payment policy, and health plan benefits and exclusions; follows-up on issues as needed; refers complex problems/issues to lead and/or supervisor.


• Reviews KPHC work queues emergency hospital patients related to registration, insurance and other financial requirements; contacts patients, verifies insurance, and resolves issues as appropriate.


• Maintains knowledge of insurance/managed care requirements, and outpatient and/ or inpatient policies and procedures.


• Collects cash, check or credit card payments for collectible services; verifies checks have accurate and current information; ensures valid authorization for all credit card payments; validates checks and credit slips; issues receipts; refunds customers for overpayment of services within authorized limits; obtains all appropriate documents and signatures.


• Balances monies, checks, credit card charge documents and daily cash register receipts; reconciles any discrepancies; prepares bank deposit; operates electronic draft capture for charge cards; reconciles and resolves any discrepancies; remits deposit to bank; places change fund order from bank; maintains change fund; buys and sells change from various departments; resovles any balance discrepancies.


• Orders departmental supplies as needed.


• Demonstrates knowledge, skills, and abilities necessary to provide culturally sensitive care and/or service.


• Performs other duties and accepts responsibility as assigned.

Qualifications:

• Two years medical insurance/billings (claim preparation) in health care or related experience.

• High school diploma; or equivalent combination of education (lesser) & experience may be considered in lieu of requirements.

• N/A

• Demonstrated Windows Navigation skills.
• Demonstrated knowledge of and skill in customer service, oral communication, written communication, problem solving, organizational, interpersonal relations, flexibility, initiative, detail oriented, quality management, independent judgment, confidentiality, results orientation, adaptability, team work, and diversity.
• Demonstrated knowledge of and skill in word processing and spreadsheet PC applications.

• Knowledge of KP computer applications.
• 10-key by touch.
• Knowledge of medical terminology.
• Medicare and Medicaid claims processing experience.
• Familiarity with CPT-4 / ICD9.
• Ability to work with medical charts and fee schedules.
• Financial counseling experience.
• Payment arrangement experience.