Financial Patient Advisor

1 week ago

Daly City, California, United States AHMC Healthcare Full time

Position Overview:

The primary role of the Insurance Verifier/Financial Advisor is to guarantee that suitable reimbursement options are established for the services rendered. This includes assessing patients for potential eligibility for Medi-Cal or Charity Care if they lack insurance or are underinsured. Key responsibilities include:

  1. Verification of patient demographics and insurance details.
  2. Timely assessment of payer and patient financial responsibilities, along with necessary notifications and initial authorizations.
  3. Ensuring that required authorizations are secured for initial hospital admissions.
  4. Compliance with both governmental and non-governmental program regulations.
  5. Clear communication with patients regarding their benefits, program requirements, and financial responsibilities, enabling informed decisions.
  6. Providing information on self-pay discounts when no other options are available and establishing payment plans as necessary.
  7. Discussing financial liabilities for services provided and collecting payments as applicable.

Key Responsibilities:

General Duties include:

  1. Conducting insurance verifications and notifications for admissions, while obtaining necessary tracking or reference numbers for various types of admissions and procedures.
  2. Advising patients and their families about insurance benefits, exclusions, and financial obligations.
  3. Determining primary coverage when multiple insurances are involved and verifying insurance eligibility related to services provided.
  4. Collecting payments and arranging payment plans when necessary.
  5. Obtaining signed acknowledgments of financial responsibility from patients and completing necessary regulatory forms.
  6. Collaborating with the collections team to monitor patient accounts effectively.
  7. Evaluating patient eligibility for various insurance programs and gathering necessary documentation for billing.

Patient Interaction:

Engaging with patients, case managers, and healthcare providers to relay information about applicable private, federal, state, and county aid programs. This includes:

  1. Ensuring that all necessary authorizations are obtained prior to elective services.
  2. Providing counseling on financial options and assisting patients in understanding their financial responsibilities.
  3. Documenting all relevant information and counseling activities in accordance with departmental policies.
  4. Resolving issues related to billing and reimbursement with various agencies.

Qualifications:

Minimum Education:
High school diploma or equivalent required. A bachelor's degree in business, hospital administration, or public health is preferred.

Minimum Work Experience:
At least 1 year of experience in Patient Accounting, Insurance Verification, or Admissions within the last 5 years, preferably in an acute care environment.

Required Skills:
Proficiency in insurance benefit verification, hospital credit and collections processes, and knowledge of the roles of various departments impacting reimbursement. Strong communication skills and proficiency in Microsoft Office and relevant software applications are essential.

This position requires the ability to maintain confidentiality, demonstrate professionalism, and effectively collaborate with various stakeholders to ensure optimal patient financial care.

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