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.

• Verification of demographic and insurance information provided.
• Accurate and timely determination of payer and patient liability, and notifications and initial authorizations required.
• Validate that required authorizations for elective surgery and notification of admissions are obtained for initial hospital stay.
• Adherence to government and non‑government program requirements.
• Communicating effectively and/or discuss with patients as to benefits, program requirements, and patient financial responsibility.
• 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.
• Provides information for uninsured and underinsured patients regarding the self‑pay discounts and Financial Assistance (Charity program) when no other options are available.
• Sets up payment arrangements as needed.
• Other duties as assigned.

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; provides 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 aid 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…