Job Summary:
This job exists to ensure that all patients membership status/alternative payor information is accurately identified & documented. Under indirect supervision, provides financial counsel to patients in a personal interview regarding payor sources and/or heath plan benefit. It will accomplish the following revenue enhancing & member service functions. Increase revenue through accurate & timely identification of membership status/alternative payors. Counsel patients on payment alternatives. Resolve any member/patient disputes regarding eligibility for service.
Essential Responsibilities:
This description is for recruitment posting purposes only. It has not received full HR review and approval.
- Confidentially probes patients who have been referred by staff such as inpatients/outpatient registration, department administrators, physicians, nursing, utilization management & social workers about the nature of their problems as they may concern the ability to have services covered by an alternate payor (Non-member, Coordination of Benefits, Third Party Liability, Workers Compensation) or issues dealing w/ membership.
- If the patient is determined to be ineligible, uses independent judgment to identify an alternate payor or identify the patient as medical indigent.
- Uses knowledge of Workers Compensation, Commercial Insurance Plans, Third Party liability, outside agencies, & governmental regulations for government programs; patient interview & observation; analysis of financial data; & physicians notes in order to accurately identify an alternate payor.
- Skillfully probes patients about their financial status, counsels & make arrangements for direct payment, status as an indigent, potential enrollment in a government sponsored program, or direct billing to patient.
- If the patient is determined to be indigent & not be able to qualify for any governmental program, completes a KP medical Financial Assistance application & based on analysis of patients financial information, approved medical; Financial Assistance up to $2,000 value or recommended approval to supervisor when amount exceeds $2,000.
- Determines patients ability to pay based on analysis of patients financial information & negotiates & approved payment arrangements based on patients financial status.
- Provides functional guidance to the support staff & trains support staff & physicians on new/revised process.
- Acts as a patient/member advocate & uses knowledge of external & internal social service agencies to accurately refer patients to social services.
- Retrospectively reviews diagnosis & treatment records to identify potential Third Party Liability & Workers Compensation cases.
- Refers identified cases to the Billing Department.
- Screens for potential eligibility for KP membership through Government Programs (Medi-Cal, Medicare, transition Plan, etc.) & refers to Member Services.
- Obtains pre-authorization for services from employers or other insurance carriers.
- Coordinates & collects conversion dues for KP.
- Checks patient information against update eligibility using on-line systems.
- Places telephone calls to appropriate departments (Membership Accounting, Sales & Marketing, etc.)
- Ensures that all reviewed documentation in the billable jacket or on the superbill is complete & obtains any missing or needed information.
- Promotes, ensures, & improves customer service to internal/external customers by demonstrating skills which are consistent w/ the organizations philosophy of providing extraordinary customer relations & quality service.
Basic Qualifications:
Experience

* Minimum of 2 years relevant experience (health care billing, collections) sufficient to analyze financial information to determine/negotiate financial arrangements
* Experience in reviewing & analyzing financial information to assess ability to pay required
* Experience w/ automated data bases of PC systems required
* Knowledge of workers compensation coordination of benefits & third party liability rules & regulations
* Medical terminology & knowledge of health care billing practices required
* Knowledge of registration bill accounting & collections required
* Able to use RMIS, CARG, KPDS, OPAS & ARRS

Education

• N/A

License, Certification, Registration

• N/A

Additional Requirements:

• N/A

Preferred Qualifications:

• N/A

Notes:

* Will be included in weekend rotation.

* May include consecutive weekend coverage as operationally needed.

* Will work holidays.

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