PATIENT FINANCIAL ADVISOR

Overview

The primary purpose of the Insurance Verifier/Financial Advisor position is to ensure that appropriate reimbursement resources are in place for services provided, or that patients are screened for potential Medi-Cal or Charity Care qualification if they are not insured or are underinsured. This includes the following:

1) Verification of demographic and insurance information provided.

2) Accurate and timely determination of payer and patient liability, and notifications and initial authorizations required.

3) Validate that required authorizations for elective surgery and notification of admissions are obtained for initial hospital stay.

4) Adherence to government and non-government program requirements.

5) Communicating effectively and/or discuss with patients as to benefits, program requirements, and patient financial responsibility.

6) Provides options for care and placement that allow for informed decisions by the patient and his/her family while protecting the financial interest of the AHMC Seton Medical Center. 7) Provides information for uninsured and underinsured patients regarding the self-pay discounts and Financial Assistance (Charity program) when no other options are available.

8) Sets up payment arrangements as needed.

9) Other Duties as assigned.

Responsibilities

1. General Duties

Performs insurance verifications, insurance notifications, obtains tracking numbers as applicable of all Direct, Urgent and Elective admissions, observation services and procedures

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.

Obtains signed patient 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 AHMC Seton Medical Center Business Services collections staff to monitor patient accounts.

Determines patient third party insurance coverage and/or government programs, validates benefits pertinent to services provided at Seton Medical Center. Gathers and analyzes all patient information on medical needs, financial resources and circumstances, residential status, duration/type of care, patient eligibility for private, federal, state and county program coverage; provide full documentation for billing within limits specified by the appropriate agency and coverage source

Interpret and relay provisions and requirements of applicable private, federal, state and county aide programs to patients, case managers and physicians, explaining all obligations and rights under the given programs.

Ensures appropriate authorizations and/or TARs are obtained prior to elective services being provided.


Provide all alternatives at hand and counsel patients regarding realistic financial ability to pay for medical care. Interview and correspond with patients, relatives, attorneys, employers and welfare agencies to obtain information, explain policies, receive payment and arrange payment plans. Documents all pertinent information and financial counseling activities in accordance with department and /or regulatory policies and/ or procedures.

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.

Resolve problems involving interfacing of various private and government agencies to ensure appropriate billing and reimbursement for services.

Apply sensitivity to the patient's medical situation in the counseling of a patient about his/her financial relationship to services provided to minimize impact during care while assuring that the patient can make informed choices about it.

Interact professionally with AHMC Seton Medical Center Central Business Office staff to obtain all pertinent information protecting patient confidentiality while ensuring all components required for reimbursement are obtained.


Define the Charity Care policy, provide charity or financial assistance applications, and provide Medi-cal applications to patients. Works closely with the patient and/or patient's family to obtain required information and review final determination.


Calculates figures and amounts such as adjustments, discounts, proportions, and percentages for account accuracy

Assists patients when requested with billing inquiries, patient financial liability and insurance payment issues. Requests adjustments, refunds, validate all authorizations for credit card payments and credibility of personal checks.

Maintains knowledge of all insurance/managed care requirements and procedures


Performs other duties and accepts responsibility as assigned.

• The employee must frequently lift up to 25 pounds and push/pull up to 25 pounds. Specific vision abilities required by this job include close vision.
• The duties of this job include possible exposure to gases and fumes, blood and body fluids, and hazardous chemicals; the employee must understand and demonstrate the ability to take protective actions, following established guidelines. The noise level in the work environment is usually quiet.

2. Demonstrates maturity and accountability for job performance. Supports the philosophy,

Objectives and goals of the division and assesses areas of personal and professional growth.

• Maintains an effective rapport with patients, visitors, physicians, and other personnel within the department and hospital.
• Works collaboratively with other staff members to provide continuous service to the organization.
• Demonstrates good judgment and analytical ability in preparing work for review.
• Promotes confidentiality and uses complete discretion when discussing information.
• Appears well groomed and observes established dress guidelines, visibly wearing the photo/name identification badge.
• Demonstrates ability to express self in all areas of communication (verbal, written, non-verbal).
• Demonstrates knowledge of current computer systems used in the organization.
• Completes assignments accurately and on time.
• Willingly accepts assignments to special projects.
• Adheres to identified work schedule.
• Is punctual in attendance to meetings.
• Provides proper notification for absence as per hospital policy as evidenced by Kronos time and attendance records.

3. Supports and promotes excellence in customer/guest relations.

• Demonstrates caring. If unable to assist an individual in need, offer to find someone who can.
• Addresses all individuals courteously.
• Responds to all inquiries promptly and courteously.
• Works together in the spirit of teamwork.
• Share information so that the people who need to be aware of the facts are informed.

Nonessential Functions

Nonessential functions are those tasks, duties, and responsibilities that are not critical to the performance of the job. Following are the nonessential functions of the job, along with the corresponding performance standards.

• Maintains positive, professional attitude toward special requests/projects.
• Demonstrates willingness to take on additional responsibilities.
• Responds to requests in a timely, organized, and efficient manner.

Qualifications

Minimum Education

• High school graduate or equivalent required.
• A baccalaureate degree from an accredited college or university with a degree in business, hospital administration or public health preferred.

Minimum Work Experience

• Minimum of 1 year of Patient Accounting/Insurance Verification and/or Admitting experience in an acute care setting.

Required Licenses/Certifications

N/A


Required Skills, Knowledge and Abilities

• Demonstrated expertise in insurance benefit confirmation and follow-up, and hospital credit and collections processes.
• Demonstrated knowledge of the role that Utilization Review, Discharge Planning (Case Management), Admissions, Medical Records, and related departments all have on the impact of reimbursement.
• Ability to work well with a variety of positions, including physicians, Case Management, nurses, Admitting and Patient Financial Services staff.
• Proficient with Microsoft Office Suite, current ADT applications and database management.
• Ability to utilize software applications to maximize automation and efficiency.
• Able to learn new software applications and/or programs as needed.