Patient Financial Advisor

Job Summary

This position is responsible for determining patient financial liability and completing the financial assessment, assisting in the discovery of the patient income and assets and in identifying the potential appropriate funding source. The position requires interpretation of information relating to regulatory and statutory requirements, ability to adjudicate insurance benefits and coverage, and interpret viability of financial assistance programs. The Patient Financial Advisor completes a financial assessment, requests patient payments, and makes appropriate referrals to other designated financial assistance vendors.

The designated vendors may include Medicaid eligibility processing, Worker Compensation and Third-Party Liability, self‑pay assistance, or other community resources. The position determines patients ability to pay based on an assessment of assets and liabilities and negotiates payment arrangements and/or qualification for financial assistance. This is an expert level position working under minimal supervision. It requires an understanding and sensitivity to confidential patient and family financial situations and special individual needs.

The Patient Financial Advisor is a liaison with Patient Financial Services and the clinical teams including Social Workers (internal and external), Care Management and Community Services Offices and other local agencies. In doing so, this position will ensure maximum cash flow and reimbursement for Kaiser Permanente NW Foundation Hospitals and acts as a facilitator in resolving patient liability issues. The Patient Financial Advisor will respond to direct requests from clinics for evaluation and assessment of a patient’s financial situation.

Independent decisions are required within the scope of responsibilities including authorization of payment means or sources, which impact sources of revenue. Major monetary decisions are subject to review and approval beyond predetermined limits.

• Review patient information provided by referring party and/or meet with patient/family member to complete all insurance and financial records or refer if there is a vendor designated to perform these responsibilities.
• Validate eligibility and benefits from insurance carriers for Emergency, Outpatient, Inpatient encounters prior to, during and post services, including continued monitoring for eligibility, authorization of insurance and medical coverage on active patient accounts.
• Gather and analyze all patient information pertaining to financial resources and circumstances.
• Identify commercial, self‑pay or under‑insured account coverages and follow up with the patient/family to request payments, negotiate payment plans and, if necessary, ensure a Medicaid or financial assistance application is initiated.
• Notify insurance carriers of intent to admit and initiate authorization for payment of stay.
• Advise and educate patients of their financial care responsibilities, related to current services.
• Understand the work processes of Patient Access Representative with abilities to perform such that they are accountable to ensure complete and accurate patient admissions/registrations, according to organization policy and procedures and regulatory requirements.
• Identify, receive internal referrals for or request from patients who may be at financial risk and/or require assistance to assure payment for current, pending, or prior medical services.
• Interview patients regarding possible workers compensation coverage, Coordination of Benefits and/or Third-Party Liability.
• Determine patients ability to pay based on an assessment of assets and liabilities and negotiate and approve payment arrangements based on patients financial status and counselors sound judgment according to policy.
• Provide patient liability information to and collect from patients based on guidelines and/or systems provided by the department, including but not limited to co‑payments, deductibles, co‑insurance, deposits, outstanding prior balances.
• Recognize knowledge of medical terminology, diagnostic related groupings (DRGs/MSDRGs), diagnosis code (ICD‑9‑CM) and common procedure…