Regional Patient Financial Advisor NW Foundation Hospitals

Job Summary

The position is responsible for determining non-KP coverages for patient financial liability and completing the financial assessment, assisting in the discovery of the patient income and assets and in identifying the potential appropriate funding source. This position requires interpretation of information relating to regulatory and statutory requirements, ability to adjudicate insurance benefits and coverage, and interpret viability of financial assistance programs.

The role of this position is to support the work at the designated home location with the ability to assist with work assigned at both Kaiser Permanente NW Plan Hospitals. The Patient Financial Advisor completes a financial assessment, requests patient deposits for payment arrangements and makes appropriate referrals to other designated financial assistance vendors. The designated vendors may include Medicaid eligibility processing, Worker Compensation and Third-Party Liability, self-pay assistance, or other community resources.

This position determines patients ability to pay based on an assessment of assets and liabilities and negotiates payment arrangements and/or qualification for financial assistance.

This is an expert level position working under minimal supervision. This position requires an understanding and sensitivity to confidential patient and family financial situations and special individual needs at time of service within the hospitals. The Patient Financial Advisor is a liaison with Patient Financial Services and the clinical teams including Social Workers (internal and external), Care Management and Community Services Offices and other local agencies.

In doing so, this position will ensure maximum cash flow and reimbursement for Kaiser Permanente NW Foundation Hospitals and acts as a facilitator in resolving patient liability issues. This position will respond to direct requests from clinicians for evaluation and assessment of patients financial situation. Independent decisions are required within the scope of responsibilities including authorization of payment means from payors or other sources, which impact revenue.

Major monetary decisions are subject to review and approval beyond predetermined limits.

This position requires the following:

1) Ability to ensure accurate coverages added to the patient account in a timely manner,
2) Accurate and timely assessment of payer and patient liability;
3) Compliance with federal, state, and local regulations;
4) Effective communication with patients regarding personal payment liabilities and options for meeting those obligations. The PFA must create a positive customer experience for all patients through personalized care.

Percent of time for essential responsibilities represents a daily requirement of work duties.

• Principle Accountabilities:
• 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 at time of service, (emergency, outpatient, inpatient) hospital encounters prior to admission from the emergency room, during and post hospital 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; and provides financial screening advice to patients, when appropriate, regarding payment options such as Medical Financial Assistance (MFA) application, Medicaid assessment.
• Identifies commercial, self-pay or under insured account coverages and…