Patient Financial Specialist-Admitting

Job Description:

Education:

Required: High School Diploma, GED or higher level degree if hired after March 1, 2025

Licensure/Certification:

N/A

Experience:

Preferred: Prior experience in admitting registration or insurance verification and benefit information in a healthcare setting

Essential Responsibilities:

• Demonstrates compliance with Code of Conduct and compliance policies, and takes action to resolve compliance questions or concerns and report suspected violations.
• Conducts bedside visits and/or initiates phone calls with patients who have financial liabilities which include deductibles, co-pays, out of pocket coinsurance to secure timely payments on accounts; educates patients on their insurance benefits and how their liability was calculated.
• Determines patient financial responsibility and eligibility through Insurance, Federal, State, and/or County government benefits; contacts appropriate agencies to verify assumptions of liability; investigates alternate payment sources for Self Pay patients; negotiates cash flat rates on accounts where the patient has no linkage to government programs.
• Ensures accounts pending government eligibility have been approved and/or denied; conducts follow up on status of financial applications (weekly).
• Acts as a liaison with case management, physicians, social services, nurses and the Medi-Cal contract workers, to ensure maximum reimbursement is achieved at all times.
• Reviews daily pre-admission, admissions, ED, and Inpatient census reports to identify patient’s financial responsibility and/or missed opportunities.
• Obtains complete and accurate patient information including possible insurance and financial information by communicating with patients, family members, and physicians regarding their stay; documents all payor and financial information in STAR system; reviews accounts for proper plan codes, financial class and patient type.
• Ensures that all required insurance authorizations/pre-certifications have been obtained to ensure optimum reimbursement from payors.
• Ensures that all patient access paperwork and patient signatures, as per organizational policies, including patient HIPAA regulation information, and forms that are necessary for the appropriate department services to be completed are obtained; assures patients are informed of their rights.
• Checks the FAX machine throughout the day for any patient referrals requested by hospital staff; Unit Secretaries have the capability to put in an order for a Patient Financial Specialist.
• Assists patients with completion of Government Assistance Applications and/or Financial Assistance Applications; educates patients on required documents for the application process.
• Obtains and scans Insurance cards, photo identification, authorizations, orders, advanced directives, and any other pertinent documentation for medical records and billing, when necessary.
• Completes the Medicare Screening Form for all Medicare patients and adheres to completion per Medicare requirements.
• Utilizes time management skills to ensure completion of daily processes.
• Conveys required guidelines to reduce bad debt and charity debt goals.
• Sets up payment plans with patients; documents payment arrangements in the patient accounting system.
• Maintains registration error accuracy rate of
• Maintains knowledge of Social Security, Medi-Cal, COBRA and Crime Victims programs.

Essential Skils:

• Ability to use Microsoft Office Suite (Word, Excel, Outlook, PowerPoint) and other relevant software applications
• Ability to operate general office equipment (i.e., computer, printer, scanner, telephone, etc.)
• Knowledge of the authorization process, various pay sources available and principles of the managed care requirements
• Knowledge of medical terminology, payment processing, hospital based federal rules, regulations and procedures, safety practices
• Ability to provide excellent customer service to all patients, visitors, co-workers and guests
• Written and verbal communication skills
• Ability to handle difficult and stressful situations in a calm and professional manner