Under indirect 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. Provides functional direction to Business Service Representatives and Receptionists. Determines and approves Medical Financial Assistance and payment arrangements.
Upholds Kaiser Permanentes Policies and Procedures, Principles of Responsibilities and applicable state, federal and local laws. Confidentially obtains or reviews and records patient financial and demographic information. Coordinates with inpatient/outpatient admission and registration for identification of potential alternate payer sources. Interviews patients to determine financial status, counsels and makes arrangements for direct payment, potential enrollment in a government sponsored program or direct billing to the patient. Completes Medical Financial Assistance applications based on analysis of patient financial information. Provides functional guidance to the support staff and informs support staff and physicians on new and revised processes. Acts as a patient/member advocate and uses knowledge of external and internal Social Services agencies for patient referral. Retrospectively reviews diagnosis and treatment records to identify potential Third Party Liability and Workers Compensation cases. Screens for potential eligibility for KP Membership through government programs (Medi-Cal, Medicare, transition plan, etc.). Obtains pre-authorizations for services from employers and other insurance carriers. Coordinates and collects conversion dues for KP coverage. Checks patient information against updated eligibility using on-line systems (Foundations). Places telephone call to the appropriate departments (CSC, Sales and Marketing etc.) in cases where group eligibility is not updated. Ensures that all documentation in the billable jackets is complete and obtains missing or needed information. Establishes and maintains courteous, cooperative relations with the public, patients, and other personnel. Performs other related duties as required.