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Financial Counselor On Call Edwards, CO



Description

Under direct supervision, provides financial counseling to members/customers/patients in a personal interview to create a payer source for Inpatient & Outpatient self-pay accts. Identifies potential Third Party liability, Compensation, Commercial, COB & Gov-t programs. Verifies coverage, eligibility, pre-authorization, billing addresses & assists w/ collection of patient liability. Initiates payment plans as appropriate. Ensures all documentation is complete & assists w/ questionable eligibility. Screens & directs correspondence, conducts periodic desk audits to identify backlogs & provides feedback to management. Makes members/customers/patients & their needs a primary focus of one's actions; develops & sustains productive member/customer/patient relationships. Actively seeks information to understand member/customer/patient circumstances, problems, expectations, & needs. Builds rapport & cooperative relationship w/ members/customers/patients. Considers how actions or plans will affect members/customers/patients; responds quickly to meet member/customer/patient needs & resolves problems. The percentage of time working w/ members versus customers may vary depending on work location.

Essential Functions:
- Works w/ members/customers/patients in a friendly & knowledgeable manner to discuss, address & resolve their concerns regarding patient liability. Interviews & pre-registers patient to obtain/determine payer source, financial & demographic info, & obtain appropriate signatures. Works w/ members/customers/patients who may not understand their insurance coverage & the concept of patient liability. Makes decisions w/in policy. Documents member/customer/patients complaints.
- Determines member's/customer's/patient's ability to pay & make payment arrangements & initiates payment plans as appropriate; identifies the member/customer/patient as medically indigent, & refers member/customer/patient to social srvs &/or other internal & external agencies as appropriate.
- Screens & inform members/customers/patients of various healthcare financial assistance programs, including payment plans, Kaiser Medical Financial Assistance, & Gov-t-sponsored programs. Assists members/customers/patients w/ application for Medical Financial Assistance.
- Use Kaiser Permanente's electronic medical record screens to track approval, denial, extension, etc. Identifies an alternate payer linkage or potential TPL or Workers Compensation cases; refer as appropriate.
- Verifies coverage on potential COB cases by calling insurance carriers.
- Verifies eligibility for KP membership through Gov-t programs using online systems (Medicare, transition plan, etc).
- Verifies pre-authorization for srvs in cases where group eligibility is not updated or there is a potential for insurance fraud issues.
- Convey estimates of the member/customer/patient responsibility portion of the billed cost of srv. Ensures that all documentation is complete & obtains missing or needed info to members/customers/patients under deductible, coinsurance, & standard copay benefit designs based on established charge estimates for common procedures.
- If capacity allows, may assist in providing reports.
- Provides functional guidance & informs internal customers & physicians on new & reviewed processes. Conducts periodic desk audits to identify backlogs & work queue issues. Provides feedback to Mgmt, as needed, for training requirements & updates. Trains staff regarding patient liability & benefit issues.
- Has initial conversation about related patient liability regarding treatment in medical office/hospital setting.
- Works designated KP electronic medical record systems work queues, as assigned. Screen & direct correspondence as needed.
- Works to cooperatively share/gather info on member/customer/patient liability & benefit issues.
- Perform other related duties, as required.
- In addition to defined technical requirements, accountable for consistently demonstrating srv behaviors & principles defined by the Kaiser Permanente Srv Quality Credo, the KP Mission as well as specific Deptal/organizational initiatives. Also accountable for consistently demonstrating the knowledge, skills, abilities, & behaviors necessary to provide superior & culturally sensitive srv to each other, to our members/customers, & to purchasers, contracted providers & vendors.


Qualifications:

Basic Qualifications:
Experience
- Three (3) years of relevant experience in Health Care billing (i.e. provider billing), Health Care collections, or health care clinic or hospital operations experience required.
- Experience in reviewing and analyzing financial information to assess ability to pay required.
- Experience with healthcare business information systems.
- Experience in using a computer keyboard in performing assigned duties.
Education
- High School graduation or General Education Development (GED) Diploma required.
License, Certification, Registration
- Certificate of completion of a course in Medical Terminology or required within six (6) months of employment.

Additional Requirements:
- Demonstrated customer service skills, customer focus abilities and the ability to understand Kaiser Permanente customer needs.
- Ability to demonstrate knowledge of and to utilize Government programs and alternate payer source (Workers Compensation, TPL, COB, Commercial, etc.).
- Excellent verbal and written communication skills and interpersonal skills required.
- Excellent time management, personnel management, and organizational skills.
- Willingness to work in a Labor/Management Partnership environment required.
- Ability to communicate complex issues.
- Typing test 25 words per minute.

Preferred Qualifications:
- Bilingual Preferred


Primary Location: Colorado,Edwards,Edwards Medical Offices 56 Edwards Village Dr.

Scheduled Hours (1-40): 1

Shift: Day

Working Days: Mon-Fri

Schedule: Call-in/On-Call

Job Type: Standard

Employee Status: Regular

Employee Group: SEIU - Local 105

Job Level: Individual Contributor

Job: Accounting, Finance and Actuarial Services

Public Department Name: Patient Services


External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.

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