Financial Counselor

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 heath plan benefit. It will accomplish the following revenue enhancing & member service functions. Increase revenue through accurate & timely identification of membership status/alternative payors. Counsel patients on payment alternatives. Resolve any member/patient disputes regarding eligibility for service.

This description is for recruitment posting purposes only. It has not received full HR review and approval. - 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. - Uses knowledge of Workers Compensation, Commercial Insurance Plans, Third Party liability, outside agencies, & governmental regulations for government programs; patient interview & observation; analysis of financial data; & physicians notes in order to accurately identify an alternate payor. - 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. - If the patient is determined to be indigent & not be able to qualify for any governmental program, completes a KP medical Financial Assistance application & based on analysis of patients financial information, approved medical; Financial Assistance up to $2,000 value or recommended approval to supervisor when amount exceeds $2,000. - 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.