Kaiser Permanente Northwest
Patient Financial Advisor
Kaiser Permanente Northwest, Oregon, Wisconsin, United States, 53575
Job Summary
This position is responsible for determining 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. The 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 Patient Financial Advisor completes a financial assessment, requests patient payments, 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. The 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. It requires an understanding and sensitivity to confidential patient and family financial situations and special individual needs. 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. The Patient Financial Advisor will respond to direct requests from clinics for evaluation and assessment of a patient’s financial situation. Independent decisions are required within the scope of responsibilities including authorization of payment means or sources, which impact sources of revenue. Major monetary decisions are subject to review and approval beyond predetermined limits.
Essential Responsibilities
Review patient information provided by referring party and/or meet with patient/family member to complete all insurance and financial records or refer if there is a vendor designated to perform these responsibilities.
Validate eligibility and benefits from insurance carriers for Emergency, Outpatient, Inpatient encounters prior to, during and post services, including continued monitoring for eligibility, authorization of insurance and medical coverage on active patient accounts.
Gather and analyze all patient information pertaining to financial resources and circumstances.
Identify commercial, self‑pay or under‑insured account coverages and follow up with the patient/family to request payments, negotiate payment plans and, if necessary, ensure a Medicaid or financial assistance application is initiated.
Notify insurance carriers of intent to admit and initiate authorization for payment of stay.
Advise and educate patients of their financial care responsibilities, related to current services.
Understand the work processes of Patient Access Representative with abilities to perform such that they are accountable to ensure complete and accurate patient admissions/registrations, according to organization policy and procedures and regulatory requirements.
Identify, receive internal referrals for or request from patients who may be at financial risk and/or require assistance to assure payment for current, pending, or prior medical services.
Interview patients regarding possible workers compensation coverage, Coordination of Benefits and/or Third-Party Liability.
Determine patients ability to pay based on an assessment of assets and liabilities and negotiate and approve payment arrangements based on patients financial status and counselors sound judgment according to policy.
Provide patient liability information to and collect from patients based on guidelines and/or systems provided by the department, including but not limited to co‑payments, deductibles, co‑insurance, deposits, outstanding prior balances.
Recognize knowledge of medical terminology, diagnostic related groupings (DRGs/MSDRGs), diagnosis code (ICD‑9‑CM) and common procedure terminology (CPT 4/APC) codes to determine benefits and estimate service cost.
Recognize knowledge of other pertinent federal and state health care regulations such as HIPAA and EMTALA, CMS, TJC, etc.
Analyze patients financial information and provide financial screening advice to patients, when appropriate, regarding payment options and scheduling and location alternatives.
Assist patients with understanding their benefits when a cost‑share is owed.
Complete CMS regulatory forms with patient or representative based upon admission status, in partnership with Care Management (IMM, MOON, Code 44).
Inform and deliver bill summary when financial class changes from a covered payor to a self‑pay status, including explanation of financial obligation going forward throughout the stay.
Determine need to consult with Care Management personnel and physicians regarding status of patient admission and insurance requirements and collaborate as needed.
Collaborate with Patient Financial Services, Health Information Management, and Clinical Information Systems for regional requirements of patient information, service outcomes, and status of accounts.
Assist financial assistance vendors/department, when in compliance with the vendor contract, to assure completion of any paperwork that is necessary to obtain payment from appropriate payors, workers compensation case or third‑party liability, or work directly with the patient to assist, if there is not a designated vendor.
Follow‑up with patient to resolve any difficulties, completing required paperwork, as appropriate.
Research and resolve complex problem accounts at the time of service. Patients may require intensive follow up with resolution prior to discharge.
Document all activity pertaining to patients account in the Kaiser Permanente EMR (Electronic Medical Record) system of record (KP HealthConnect).
Review and follow up on electronic reports for incomplete accounts, ensuring all required data fields for insurance verification, reporting and claims submission are accurately completed, to ensure a clean bill.
Perform audits to determine the accuracy and completeness of the data collected on the information and contact is handled confidentially and the patient is treated with dignity, regardless of financial circumstances.
Collect statistical data and prepare reports, as needed.
Maintain records during system downtime and assist in recovery processes.
Perform all or part of duties and responsibilities at the direction of department management based on appropriate needs of the department, and all other tasks and duties as assigned by supervisor.
Work collaboratively with Hospital, Clinic, Emergency Department and Member Services personnel to create a customer friendly environment.
Accommodate work schedule and shift flexibility according to department needs.
Contribute to the success of the organization by participating in the organizational and customer service/employee relations action plan programs, keeping current on new developments within the Kaiser Permanente Organization.
Maintain working knowledge of Fair Debt Collection Laws along with State and Federal rules and regulations for billing Medicaid, Medicare, Champus, etc.
Perform other duties as needed or assigned.
Experience Basic Qualifications
Two (2) years of work experience including twelve (12) months of hospital, preauthorization, financial counseling, insurance company or billing experience required or graduate of a health vocational program (12‑18‑month duration.) required.
Three (3) years experience in dealing with the public in a customer service role.
Education
High School Diploma or General Education Development (GED) required.
One (1) year post high school business or college course work.
License, Certification, Registration
Healthcare Access Associate Certificate within 6 months of hire from National Association of Healthcare Access Management.
Basic Life Support required at hire.
Medical Terminology Certification.
Additional Requirements
Hospital Patient Registration experience.
Basic knowledge and use of computer and computer keyboard.
Able to pass PC skills assessment and keyboarding test [a rate of 6,000 keystrokes/hour is required to pass].
Proficient in medical terminology.
Able to pass KP standardized test.
Must be able to apply benefit circumstances to fee schedule quotation to determine member/patient cost share obligation.
Able to pass fee/benefit test.
Capable of making decisions and working independently to accomplish all responsibilities, as well as maintain an in‑depth understanding of job duties and operational changes where financial counseling decisions have significant financial and medical implications.
Demonstrated knowledge of the admitting and registration processes and requirements. Effective interpersonal and communications skills. Knowledgeable regarding the impact of Utilization Review, Discharge Planning, Admissions, and other related departments on reimbursement.
Demonstrated ability to understand and interpret benefit coverage information, including KP Plans, Medicaid, Medicare, Commercial coverages, and other insurance plans.
Cash handling experience.
Ability to work independently under limited supervision, take initiative, deal effectively with constant change, and willingly accept responsibility.
Computer experience and training in Windows and MS Word.
Preferred Qualifications
Three (3) years as a Patient Access Representative II or Pre‑Registration Representative, or equivalent, in a 24/7 hospital environment.
Two years of higher education preferred.
Job Details
Seniority Level: Entry level
Employment Type: Contract
Job Function: Finance and Sales
Industry: Hospitals and Health Care
Location: Portland, OR. Salary: $50,000 – $80,000 per year.
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Essential Responsibilities
Review patient information provided by referring party and/or meet with patient/family member to complete all insurance and financial records or refer if there is a vendor designated to perform these responsibilities.
Validate eligibility and benefits from insurance carriers for Emergency, Outpatient, Inpatient encounters prior to, during and post services, including continued monitoring for eligibility, authorization of insurance and medical coverage on active patient accounts.
Gather and analyze all patient information pertaining to financial resources and circumstances.
Identify commercial, self‑pay or under‑insured account coverages and follow up with the patient/family to request payments, negotiate payment plans and, if necessary, ensure a Medicaid or financial assistance application is initiated.
Notify insurance carriers of intent to admit and initiate authorization for payment of stay.
Advise and educate patients of their financial care responsibilities, related to current services.
Understand the work processes of Patient Access Representative with abilities to perform such that they are accountable to ensure complete and accurate patient admissions/registrations, according to organization policy and procedures and regulatory requirements.
Identify, receive internal referrals for or request from patients who may be at financial risk and/or require assistance to assure payment for current, pending, or prior medical services.
Interview patients regarding possible workers compensation coverage, Coordination of Benefits and/or Third-Party Liability.
Determine patients ability to pay based on an assessment of assets and liabilities and negotiate and approve payment arrangements based on patients financial status and counselors sound judgment according to policy.
Provide patient liability information to and collect from patients based on guidelines and/or systems provided by the department, including but not limited to co‑payments, deductibles, co‑insurance, deposits, outstanding prior balances.
Recognize knowledge of medical terminology, diagnostic related groupings (DRGs/MSDRGs), diagnosis code (ICD‑9‑CM) and common procedure terminology (CPT 4/APC) codes to determine benefits and estimate service cost.
Recognize knowledge of other pertinent federal and state health care regulations such as HIPAA and EMTALA, CMS, TJC, etc.
Analyze patients financial information and provide financial screening advice to patients, when appropriate, regarding payment options and scheduling and location alternatives.
Assist patients with understanding their benefits when a cost‑share is owed.
Complete CMS regulatory forms with patient or representative based upon admission status, in partnership with Care Management (IMM, MOON, Code 44).
Inform and deliver bill summary when financial class changes from a covered payor to a self‑pay status, including explanation of financial obligation going forward throughout the stay.
Determine need to consult with Care Management personnel and physicians regarding status of patient admission and insurance requirements and collaborate as needed.
Collaborate with Patient Financial Services, Health Information Management, and Clinical Information Systems for regional requirements of patient information, service outcomes, and status of accounts.
Assist financial assistance vendors/department, when in compliance with the vendor contract, to assure completion of any paperwork that is necessary to obtain payment from appropriate payors, workers compensation case or third‑party liability, or work directly with the patient to assist, if there is not a designated vendor.
Follow‑up with patient to resolve any difficulties, completing required paperwork, as appropriate.
Research and resolve complex problem accounts at the time of service. Patients may require intensive follow up with resolution prior to discharge.
Document all activity pertaining to patients account in the Kaiser Permanente EMR (Electronic Medical Record) system of record (KP HealthConnect).
Review and follow up on electronic reports for incomplete accounts, ensuring all required data fields for insurance verification, reporting and claims submission are accurately completed, to ensure a clean bill.
Perform audits to determine the accuracy and completeness of the data collected on the information and contact is handled confidentially and the patient is treated with dignity, regardless of financial circumstances.
Collect statistical data and prepare reports, as needed.
Maintain records during system downtime and assist in recovery processes.
Perform all or part of duties and responsibilities at the direction of department management based on appropriate needs of the department, and all other tasks and duties as assigned by supervisor.
Work collaboratively with Hospital, Clinic, Emergency Department and Member Services personnel to create a customer friendly environment.
Accommodate work schedule and shift flexibility according to department needs.
Contribute to the success of the organization by participating in the organizational and customer service/employee relations action plan programs, keeping current on new developments within the Kaiser Permanente Organization.
Maintain working knowledge of Fair Debt Collection Laws along with State and Federal rules and regulations for billing Medicaid, Medicare, Champus, etc.
Perform other duties as needed or assigned.
Experience Basic Qualifications
Two (2) years of work experience including twelve (12) months of hospital, preauthorization, financial counseling, insurance company or billing experience required or graduate of a health vocational program (12‑18‑month duration.) required.
Three (3) years experience in dealing with the public in a customer service role.
Education
High School Diploma or General Education Development (GED) required.
One (1) year post high school business or college course work.
License, Certification, Registration
Healthcare Access Associate Certificate within 6 months of hire from National Association of Healthcare Access Management.
Basic Life Support required at hire.
Medical Terminology Certification.
Additional Requirements
Hospital Patient Registration experience.
Basic knowledge and use of computer and computer keyboard.
Able to pass PC skills assessment and keyboarding test [a rate of 6,000 keystrokes/hour is required to pass].
Proficient in medical terminology.
Able to pass KP standardized test.
Must be able to apply benefit circumstances to fee schedule quotation to determine member/patient cost share obligation.
Able to pass fee/benefit test.
Capable of making decisions and working independently to accomplish all responsibilities, as well as maintain an in‑depth understanding of job duties and operational changes where financial counseling decisions have significant financial and medical implications.
Demonstrated knowledge of the admitting and registration processes and requirements. Effective interpersonal and communications skills. Knowledgeable regarding the impact of Utilization Review, Discharge Planning, Admissions, and other related departments on reimbursement.
Demonstrated ability to understand and interpret benefit coverage information, including KP Plans, Medicaid, Medicare, Commercial coverages, and other insurance plans.
Cash handling experience.
Ability to work independently under limited supervision, take initiative, deal effectively with constant change, and willingly accept responsibility.
Computer experience and training in Windows and MS Word.
Preferred Qualifications
Three (3) years as a Patient Access Representative II or Pre‑Registration Representative, or equivalent, in a 24/7 hospital environment.
Two years of higher education preferred.
Job Details
Seniority Level: Entry level
Employment Type: Contract
Job Function: Finance and Sales
Industry: Hospitals and Health Care
Location: Portland, OR. Salary: $50,000 – $80,000 per year.
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