Financial Counseling Representative-Hospital

Job Summary:

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 Health Connect;

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.

Essential Responsibilities:

+ 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 Health Connect;

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…