Financial Administrative Representative

Financial Administrative Representative

Location: Valencia, CA 91355

Shift: MondayFriday, 8:00 AM 4:30 PM

Summary:

The Patient Access Representative III Financial Counselor supports the patient care team by managing financial and administrative aspects of patient access services. This role is responsible for verifying insurance eligibility, obtaining authorizations, securing patient financial information, collecting patient liabilities, and providing clear explanations of financial responsibilities and payment options.

The Financial Counselor ensures patients are financially cleared for services and assists with both scheduled and unscheduled admissions while maintaining compliance with hospital policies and regulatory requirements.

Key Responsibilities:

• Patient Financial Services
• Verify insurance eligibility, benefits, and coverage details.
• Obtain pre-certifications and authorizations for inpatient and outpatient services.
• Calculate and communicate estimated patient financial responsibility.
• Collect deductibles, co-pays, and patient liabilities at point of service.
• Set up payment plans in accordance with hospital collection policies.
• Follow up on missed payments within established timelines.

• Registration & Documentation
• Ensure completion of all admission paperwork (HIPAA, Conditions of Admission, Financial Agreements, etc.)
• Provide Patient Rights and Medicare-required documentation (LTR forms when applicable).
• Accurately update patient demographic and insurance information in hospital systems.
• Ensure correct HMO medical group assignment and communicate updates when necessary.

• Insurance & Eligibility Coordination
• Review Medicare MSP and CWF for coordination of benefits.
• Identify Medicare Advantage and hospice-related cases.
• Coordinate with case management and social services on eligibility and account status.
• Assist patients with Medicaid/Medi-Cal screening and charity care applications.

• Financial Counseling & Support
• Educate patients on financial assistance programs and community resources.
• Assist self-pay patients with available financial options.
• Support patients with hospital charity applications and track submission status.

• Compliance & Communication
• Maintain HIPAA compliance and access minimum necessary information.
• Adhere to hospital compliance policies and procedures.
• Communicate effectively with physicians, case management, and patient access teams.
• Support quality assurance standards and monthly performance metrics.

• General Duties
• Assist with patient registration and admissions as needed.
• Ensure timely financial clearance of patients for services.
• Perform additional duties as assigned.

Minimum Qualifications:

Education

• High School Diploma or GED required.

Experience

• Minimum 3 years of experience in a hospital, medical office, or healthcare setting.
• Experience in pre-access, billing, insurance eligibility verification, or related functions preferred.

Certifications (Preferred)

• Certified Revenue Cycle Representative (CRCR).
• High-Risk Workplace Violence Certification (required within 6 months of hire).

Knowledge & Skills

• Understanding of third-party reimbursement (HMO, PPO, Medicare, Medi-Cal).
• Basic medical terminology.
• Strong customer service, communication (verbal and written), and organizational skills.

Equipment Used

• Computer, fax machine, printer, copier, credit card processing machine, camera.