Patient Financial Advisor (PFA)

Patient Financial Advisor

Chinese Hospital | San Francisco Bay Area

About This Role

Department

Patient Accounting

Reports to

Director of Patient Financial Services

Type

Full Time-Non Exempt

Requisition #

12739

Position Summary

The Patient Financial Advisor (PFA) offers financial advice and assistance to. patients regarding medical bills. PSA is the liaison between patients and their insurance companies; often coordinating payments and answering questions from both parties.

PFA shall ensure that appropriate reimbursement resources are in place for services provided. If patients are registered without insurance coverages, PFA will actively screen all inpatients and outpatients for other insurance coverages. Other responsibilities are: 1) verification of demographic and insurance information provided, as well as third party insurances; 2) Accurate and timely determination of payer and patient liability, and notifications and initial authorizations required; 3) Validate that required authorizations/notifications are obtained for hospital stay and outpatient services, 4) Adherence to government and non-government program requirements; 5) Effectively communicating with patients as to benefits, program requirements, personal payment liabilities, and options for care and placement that allow for informed decisions by the patient and his/her family while protecting the financial interest of Chinese Hospital Association; 6) Provides information regarding self-pay discounts when no other options are available, sets up payment arrangements as needed; 7) Discusses patient financial liability for services rendered and collects as applicable for those services; 8) Assist eligible patients in the application of Hospital Presumptive Eligibility (HPE), Full Scope Medi-Cal, and referrals to other insurance coverages if not qualifying for Medi-Cal; 9) Apply Treat Authorization Requirement (TAR) for all eligible accounts; 10) Review all assigned DNFB for appropriate billing actions.

Essential Duties And Responsibilities

• Communicate with patients and insurance companies on the phone
• Appropriately document and report payment information
• Advises patients and/or family members and Case Management (as applicable) of insurance benefits, exclusions and financial obligations. Determines primary coverage when multiple insurances are involved, collects and verifies insurance eligibility as it applies to services rendered, collects payments, deposits and/or arranges for payment plans if necessary
• Educate patients about payment options and financial assistance
• Negotiate and strategize patient payment
• Update patient accounts and balances
• Review and process patient and insurance company
• Work with pharmacies and pharmacy insurance programs to make sure prescribed medications are covered by the patient’s financial
• Provide proper documentation to patient’s insurance company to ensure coverage
• Communicate with CHA’s 3rd party billing to ensure claims are handled efficiently
• Ensure all Infusion accounts are pre-admitted, registered and financially resources
• Work with front registration during normal business hours to effectively capture uninsured/underinsured patients for financial If during off hours, PFA will reach out to the patients the next business day.
• Follows Hospital and Department policies and procedures at all times, including but not limited to: Administrative Manual, Environment of Care, Human Resources, Infection Control, Corporate Compliance, Code of Ethics,
• Attend, actively participate and complete in-services, training classes, mandatory classes, seminars/workshops, staff meetings, exercises and drills; reads all department communication and assigned
• Customer Service – Provides excellent customer service and shows compassion to all patients, visitors and co-workers. Seeks feedback to ensure all needs are met. Anticipates and recognizes the concerns of others, even if those concerns are not openly expressed.
• Communication – Keeps manager and team informed of progress, problems, development and plans. Gets along and interacts positively with co-workers and others.
• Accepts and performs other duties as assigned
  
  

Values/Core Competencies

• Integrity –We adhere to a code of values and make commitments that contribute to the welfare of our community.
• Respect – We seek to create a community within our organization that enhances self-worth of individuals working with us and for our patients. The dignity and respect shown to employees by management and by their fellow staff will be the model for caring for our patients. Management is committed to treating employees fairly, honestly and with respect. In return, management expects a commitment from employees to the values of the organization and its work on behalf of the community.
• Empowerment – we are committed to action and expect all employees to be proactive in decision making and problem solving. We delegate authority to match responsibility, expecting decision making to occur as close to the customer as possible.
• Team Work – We believe that quality, cost effective, compassionate care can only be provided through team work. The nature of our work and mission require sensitivity to the feelings and points of view of many. We work for the good of the team, are accountable for the results of the team and together share our successes or failures. We maintain an atmosphere of openness, honesty and trust.
• Accountability – We accept personal responsibility for our actions and take ownership of our results. We as individuals recognize achievement and are challenged to improve our performance by providing and accepting coaching and feedback.
• Quality Improvement – We will improve value through the process of continuous quality improvement with focus on the relationship between quality and cost. We have a sense of urgency in our search to find better ways of doing everything. We encourage others to try new ideas and measure and recognize results. We are willing to change the status quo to improve.
• Community collaboration and Benefit – We will collaborate within the limits or our resources with other agencies and providers to address the health care wellness needs of our community, recognizing that access to services must be made available regardless of an individual’s ability to pay.
• Prudent use of resources – We will use and maintain our assets and resources prudently in order to meet community expectations. Our organization requires an overall positive return on investment to carry out its mission and to invest in new programs, equipment and facilities. We believe that integration simplifies and improves the process of health care and is a means of achieving economies of scale which will ultimately reduce costs. We seek simplification in the process of patient care and the efficient use of our resources in a changing environment.
  
  

Qualifications

Required

• Medical Office Experience
• Computer proficiency (EMR knowledge a plus)
• Effective communication skills to work with patients, families, doctors and insurance providers
• Strong Customer Service
• Ability to effectively present information, both verbal and written
• Ability to take initiative, adapt to changing priorities, and work independently
• Strong time management and prioritization skills
• Knowledge of Medical Terminology including medications
  
  

Preferred

• High School Diploma or
• Bilingual in Chinese (Cantonese and/or Mandarin) or Spanish
• Knowledge of community resources and cultural
  
  

Physical Requirements

While performing the duties of this job, staff is regularly required to sit, stand, walk, talk and/or listen. He/she uses his/her hands to do computer work, write reports, do equipment set-up/cleaning/storage, clerical support, etc. He/she will be using the phone frequently. Good vision is needed to be able to read schedules, enter accurate data, etc. He/she must have good general health and demonstrate emotional stability so as to carry out the above-enumerated duties.

• Able to lift up to 30 pounds
• Use proper body mechanics when handling equipment
• Standing, walking and moving 50% of the day
  
  

Compliance Requirements

Complies with Chinese Hospital Compliance Handbook including Code of Ethics and all statutes, regulations, guidelines applicable to federal and state programs. Responsibilities include, following the guidelines and reporting suspected violations of any statute, regulations, agreements or guidelines applicable to all healthcare programs.

Base Pay Scale

Starting at $31.91-$39.26 per hour. The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, specialty and training. This pay scale is not a promise of a particular wage.