Patient Financial Advisor
Patient Financial Advisor - Grade 7
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