Financial Counseling Representative – Clinic

Under indirect supervision, advises patients and/or family members of health plan benefits and exclusions and financial obligations; collects and verifies membership and other insurance eligibility applicable to services rendered; collects payments, deposits and/or arranges for payment plans as appropriate to services; processes applications for medical financial assistance (MFA) and/or other applications as appropriate; documents interview, payment arrangements, and all other pertinent information in KP HealthConnect; assists customers with complaints or inquiries regarding bills and/or charges including, but not limited to, explanation of charges, Kaiser Permanente payment policy, and health plan benefits and exclusions.

Essential Functions:

– Advises patients and/or family members of health plan benefits and exclusions and financial obligations; determines primary coverage when multiple insurances are involved; collects and verifies membership and
other insurance eligibility applicable to services rendered; collects payments, deposits and/or arranges for payment plans as appropriate to services; obtains signed acknowledgement of financial responsibility; interviews patients as referred; obtains and completes information for MSP, Coordination of Benefits (COB) and other regulatory forms as required; collaborates with Patient Accounting collections staff to monitor patient’s account according to established criteria.

– Documents pertinent information and financial counseling activities in accordance with department and/or regulatory policies and/or procedures; communicates financial payment issues to appropriate representative in patient care area for non-urgent or emergent care to determine postponement and/or cancellation of services; informs supervisor of potential postponements/ cancellations of elective or nonurgent care.

– Proactively contacts patients to pre-register them for selected procedures and/or those patients with selected insurance coverages; advises patients of estimated cost share; arranges for deposits/pre-payment prior to procedure in accordance with department protocols and procedures.

– Obtains medical record number and benefit information for all new health plan members, visiting members (mainland health plan), and non-plan patients; completes other coordination of benefit protocols as appropriate; obtains signatures on selected insurance claim and authorization to release information/bill (IRA or other) forms; updates system to appropriate identify patients COB or other insurance status as appropriate.

– Processes applications for medical financial assistance (MFA) and/or other applications as appropriate; determines patient’s eligibility by interviewing and collecting personal financial information; identifies appropriate hospital, public and/or private financial assistance programs; collaborates and/or refers to Medical Social Services, QUEST, Utilization Management and/or external agencies as needed; obtains necessary authorizations required for services; reinforces established payment guidelines as needed; documents interview, payment arrangements, and all other pertinent information in KP HealthConnect; follows up patients as appropriate.

– Calculates and determines if member has met co-pay maximum; issues co-pay maximum card as needed; requests refunds when appropriate.

– Advises clinic and/or hospital staff regarding processing of non-KPHC charges; provides information regarding professional fees, charges for supplies, and other tools to support operations; directs staff to appropriate tools and/or department for problem resolution; answers patient inquires as needed.

– Assists customers with complaints or inquiries regarding bills and/or charges including, but not limited to, explanation of charges, Kaiser Permanente payment policy, and health plan benefits and exclusions; follows-up on issues as needed; refers complex problems/issues to lead and/or supervisor.

– Reviews and extends charges for non-automated ancillary/other department charges/documents as directed and Ambulatory Surgery Center (ASC) prior to billing; researches canceled surgeries and discrepancies; maintains file of surgery dates, patient forms and type of lens used, as applicable.

– Maintains knowledge of insurance/managed care requirements, and outpatient and/ or inpatient policies and procedures.

– Collects cash, check or credit card payments for collectible services; verifies checks have accurate and current information; ensures valid authorization for all credit card payments; validates checks and credit slips; issues receipts; refunds customers for overpayment of services within authorized limits; obtains all appropriate documents and signatures.

– Balances monies, checks, credit card charge documents and daily cash register receipts; reconciles any discrepancies; prepares bank deposit; operates electronic draft capture for charge cards; reconciles and resolves any discrepancies; remits deposit to bank; places change fund order from bank; maintains change fund; buys and sells change from various departments; resovles any balance discrepancies.

– Orders departmental supplies as needed.

– Demonstrates knowledge, skills, and abilities necessary to provide culturally sensitive care and/or service.

– Performs other duties and accepts responsibility as assigned.