Patient Financial Advisor Grade 7 San Francisco, CA
Under direct supervision, the Patient Financial Advisor (PFA) is a professional responsible for identifying appropriate financial sponsorship for members & non-members & determining their cost share obligation. This requires the following: 1) Accurate & timely assessment of payer & patient liability; 2) Compliance w/ federal, state, & local regulations; 3) Effective communication w/ patients regarding personal payment liabilities & options for meeting those obligations. The Patient Financial Advisor (PFA) must create a positive customer experience for all patients through personalized care.
Essential Functions:
- Assists members w/ understanding their benefits when a cost-share is owed
- Determines eligibility for private, federal, state, & county program coverage for patients
- Interprets & describes provisions & requirements of applicable private, federal, state, & county aid programs to patients & explains all obligations & rights under the specific program
- Gathers & analyzes all patient information pertaining to financial resources & circumstances
- Obtains treatment authorizations, as needed
- Advises patients of their financial responsibilities & arranging &/or collecting payments when appropriate
- Provides consultation to patients regarding referrals to outside agencies or to the Medical Financial Assistance & Discount Payment (MFAP) program, including reviewing & evaluating MFAP applications for completeness & accuracy & submitting applications on behalf of patients when appropriate
- Interviews patients regarding possible workers compensation coverage, Coordination of Benefits, &/or Third Party Liability
- Interacts w/ clinical staff to obtain all pertinent information protecting patient confidentiality while ensuring all components required for reimbursement are obtained
- Performs audits to determine the accuracy & completeness of the data collected in the admitting & registration process
- Ensures all required data fields for insurance verification, OSHPD reporting & claims submission are accurately completed
- Collects statistical data & prepare reports, as needed
- Noting all activities in the Kaiser Permanente system of record (KP Health Connect)
- Performs all or part of duties & responsibilities at the direction of department management based on appropriate department needs, all other tasks, & duties as assigned by supervisor
- Works collaboratively w/ Hospital, Clinic, Emergency Department, & Member Services personnel to create a customer friendly environment
- Makes decisions & works independently to accomplish all responsibilities, as well as maintain an in-depth understanding of job duties & operational changes where financial counseling decisions have significant financial & medical implications
- No supervisory responsibilities
Qualifications:
Basic Qualifications:
- Twenty-four (24) months of work experience including twelve (12) months of hospital, medical office or insurance company required
- High school diploma or equivalent
- Basic knowledge and use of computer and computer keyboard (able to pass PC skills assessment and keyboarding test (rate: 6,000 keystrokes per hour, required to pass)
- Knowledgeable regarding the legal requirements of collections
- Knowledgeable regarding the impact Utilization Review, Discharge Planning, Admissions, and other related departments have on reimbursement
- Knowledge of the admitting, registration processes, and requirements
- Proficient in medical terminology (able to pass Kaiser Permanente standardized test)
- Effective interpersonal and communications skills
- Must be able to apply benefit circumstances to fee schedule quotation to determine member/patient cost share obligation (able to pass fee/benefit test)
- Ability to interact in a sensitive manner with Kaiser Permanente patients, their families, and Kaiser Permanente staff
- Ability to multitask, organize, prioritize, and work independently with minimal supervision
- Ability to understand and interpret benefit coverage information, including KP Plans, Medical, Medicare, and other insurance
- Must be able to apply benefit circumstances to fee schedule quotation to determine member/patient cost share obligation (able to pass fee/benefit test)
- Must be willing to work in a Labor Management Partnership environment
Preferred Qualifications:
- Payment and/or payment arrangement experience preferred
- Proficient in word-processing, spreadsheet programs, etc., preferred
Skills testing: PC Skills, Keyboarding (6,000 keystrokes / hour), Medical Terminology, Fee / Benefit Test
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