Job Description

Job Summary

Under direct supervision, at the point of service provides financial counseling to patients in a personal interview to create a payer source for Inpatient and Outpatient self-pay accounts. Identifies potential third party liability, Workers Compensation, Commercial, COB, Medicare and Medi-Cal. Verifies coverage, eligibility, pre-authorization, billing addresses and assists with collection of co-pays, Medi-Cal Share of Cost (SOC), conversion dues and non-member deposits. Ensures all documentation is complete and assists with questionable eligibility. The Financial Counselor II screens and directs correspondence, conducts periodic desk audits to identify backlogs and provides feedback to the Department Administrator.

Essential Responsibilities

• Upholds Kaiser Permanentes Policies and Procedures, Principles of Responsibilities and applicable state, federal and local laws. The Financial Counselor II performs all duties currently performed by the Financial Counselor I and determines and approves Medical Financial Assistance and payment arrangements, provides reports to management, provides functional guidance to support the staff and completes Third Party insurance claims forms. If patient is determined to be indigent, assists patient with application for Medical Financial Assistance (MFAP) (members and non-members). Completes MFAP screens to track approval, denial, extension, etc. Determine patients ability to pay and make payment arrangements; identify the patient as medically indigent and refers patient to social services and/or other internal and external agencies as appropriate. Identify an alternate payer linkages or potential TPL or Workers Compensation cases; refer as appropriate. Verifies coverage on potential COB (members) cases by calling insurance carriers. Assists with collection of co-pays, Medi-Cal SOC, Conversion dues, non-member deposits, etc. Verifies eligibility for KP Membership through government programs using on-line systems (Medi-Cal, Medicare, transition plan, etc.). Verify pre-authorization for services from insurance carriers for outpatient and inpatient. Verify billing addresses for both hospital and professional services. Places telephone call to the appropriate departments (CSC, Sales and Marketing etc.) in cases where group eligibility is not updated or potential insurance fraud issues. Ensures that all documentation is complete and obtains missing or needed information including requesting charts. Establishes and maintains courteous, cooperative relations with the public, patients, and other personnel. Determine eligible coverage and add to patient account in correct filing order. Terminate any ineffective coverage. Assist with questionable eligibility and communicate as appropriate to clinical staff (pre-service) and coordinate with appropriate resources. Performs other related duties as required Informs care coordinators of non-member inpatient eligibility status (phone call) and keeps them updated. Interviews patients to obtain/determine payer source, financial and demographic information and obtains appropriate signatures. Determines if the service or item is covered under the MFAP guidelines. Complete and process Third Party insurance claim forms. Screen and direct correspondence to proper section or department. Provides reports to management as needed Faxes approval, denial, etc. letters to appropriate departments i.e. pharmacy, DME, etc. Provides functional guidance to the support staff and informs support staff and physicians on new and revised processes. Conduct periodic desk audits to identify backlogs and work queue issues. Provide feedback to DA as needed for training requirements and updates. Work designated HealthConnect work queues as assigned. May provide coverage for cashier as required. Assume other activities and responsibilities from time to time as directed.

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