Under direct supervision, the Patient Financial Advisor (PFA) is a professional responsible for identifying appropriate financial sponsorship for members and non-members and determining their cost share obligation. This requires the following: 1) Accurate and timely assessment of payer and patient liability; 2) Compliance with federal, state and local regulations; 3) Effective communication with patients regarding personal payment liabilities and options for meeting those obligations. The PFA mu... more details
Description:
Job Summary:
Under direct supervision, the Patient Financial Advisor (PFA) is a professional responsible for identifying appropriate financial sponsorship for members and non-members and determining their cost share obligation. This requires the following: 1) Accurate and timely assessment of payer and patient liability; 2) Compliance with federal, state and local regulations; 3) Effective communication with patients regarding personal payment liabilities and options for meeting those obligations. The PFA must create a positive customer experience for all patients through personalized care.
Essential Responsibilities:
Includes but is not limited to:
Assisting members with understanding their benefits when a cost-share is owed.
Determining eligibility for private, federal, state and county program coverage for patients.
Interpreting and describing provisions and requirements of applicable private, federal, state and county aid programs to patients, explaining all obligations and rights under the specific program.
Gathering and analyzing all patient information pertaining to financial resources and circumstances.
Obtaining treatment authorizations, as needed.
Advising patients of their financial responsibilities and arranging and/or collecting payments when appropriateProviding consultation to patients regarding referrals to outside agencies or to the Medical Financial Assistance and Discount Payment (MFAP) program, including reviewing and evaluating MFAP applications for completeness and accuracy and submitting applications on behalf of patients when appropriate.
Interviewing patients regarding possible workers compensation coverage, Coordination of Benefits and/or Third Party Liability.
Interacting with clinical staff to obtain all pertinent information protecting patient confidentiality while ensuring all components required for reimbursement are obtained.
Perform audits to determine the accuracy and completeness of the data collected in the admitting and registration process.
Ensure all required data fields for insurance verification, OSHPD reporting and claims submission are accurately completed.
Collect statistical data and prepare reports, as needed.
Noting all activities in the Kaiser Permanente system of record (KP HealthConnect).Performing all or part of duties and responsibilities at the direction of department management based on appropriate needs of the department, and all other tasks and duties as assigned by supervisor.
The Patient Financial Advisor works collaboratively with Hospital, Clinic, Emergency Department and Member Services personnel to create a customer friendly environment.
Supervisory Responsibilities: This position has no supervisory responsibilities.
Corporate Compliance Accountability: Consistently demonstrates the knowledge, skills, abilities, and behaviors necessary to provide superior and culturally sensitive service to each other.
Basic Qualifications:
Experience
Twenty-four (24) months of work experience including twelve (12) months of hospital, medical office or insurance company required.
Education
High school diploma or General Education Diploma (GED) required.
License, Certification, Registration
N/A
Additional Requirements:
The Patient Financial Advisor must be capable of making decisions and working independently to accomplish all responsibilities, as well as maintain an in-depth understanding of job duties and operational changes where financial counseling decisions have significant financial and medical implications.
Basic knowledge and use of computer and computer keyboard (able to pass PC skills assessment and keyboarding test [a rate of 6,000 keystrokes/hour is required to pass]).
Proficient in medical terminology (able to pass KP standardized test).
Demonstrated ability to understand and interpret benefit coverage information, including KP Plans, Medi-Cal, Medicare and other insurance.
Must be able to apply benefit circumstances to fee schedule quotation to determine member/patient cost share obligation (able to pass fee/benefit test).
Demonstrated ability to interact in a sensitive manner with KP patients, their families and KP staff.
Knowledgeable regarding the legal requirements of collections.
Ability to multitask, organize and prioritize and work independently with minimal supervision.
Demonstrated knowledge of the admitting and registration processes and requirements. Effective interpersonal and communications skills. Knowledgeable regarding the impact Utilization Review, Discharge Planning, Admissions and other related departments have on reimbursement.
Must be willing to work in a Labor Management Partnership environment.
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