Under indirect supervision, at the point of service provides financial counseling to patients in a personal interview to create a payer source for Inpatient & Outpatient self-pay accounts. Identifies potential third party liability, Workers Compensation, Commercial, COB, Medicare & Medi-Cal. Provides functional direction to Business Service Representatives & Receptionists. Determines & approves Medical Financial Assistance & payment arrangements.
Essential Functions:
- Upholds KP's Policies & Procedures, Principles of Responsibilities & applicable state, federal & local laws
- Confidentially obtains or reviews & records patient financial & demographic information
- Coordinates w/ inpatient/outpatient admission & registration for identification of potential alternate payor sources
- Interviews patients to determine financial status, counsels & makes arrangements for direct payment, potential enrollment in a government sponsored program or direct billing to the patient
- Completes Medical Financial Assistance applications based on analysis of patient financial information
- Provides functional guidance to the support staff & informs support staff & physicians on new & revised processes
- Acts as a patient/member advocate & uses knowledge of external & internal Social Services agencies for patient referral
- Retrospectively reviews diagnosis & treatment records to identify potential Third Party Liability & Workers Compensation cases
- Screens for potential eligibility for KP Membership through government programs (Medi-Cal, Medicare, transition plan, etc)
- Obtains pre-authorizations for services from employers & other insurance carriers
- Coordinates & collects conversion dues for KP coverage
- Checks patient information against updated eligibility using on-line systems (Foundations)
- Places telephone call to the appropriate departments (CSC, Sales & Marketing, etc) in cases where group eligibility is not updated
- Ensures that all documentation in the billable jackets is complete & obtains missing or needed information
- Establishes & maintains courteous, cooperative relations w/ the public, patients & other personnel
- Performs other related duties as required
Qualifications:
Pay Grade 14
Basic Qualifications:
- Minimum of three (3) years of relevant experience in health care billing, collections or financial counseling or equivalent
- High School Diploma/GED
- Certificate of completion of a course in Medical Terminology
- Typing 35 wpm. Typing score must be current within one (1) year. Please contact Human Resources for testing.
- Demonstrated ability in patient registration, admissions & billing practice required
- Ability to demonstrate knowledge of & to utilize Government Programs & alternate payor sources (Workers Compensation, TPL, COB, Commercial, etc)
Notes:
- This is an on call position, schedule varies
External hires must pass a background check/drug screen.
We are proud to be an equal opportunity/affirmative action employer.