Financial Rep Access Dept

Palomar Health•Poway, CA

About The Position

This position serves as the primary contact for patients and their families regarding funding options for both inpatient and outpatient services. The role involves managing the daily tasks of securing funding for patients across various stages, including scheduling, pre-registration, registration, and post-registration. Key responsibilities include screening all daily admissions, educating referring physician offices, patients, and families on hospital policies and procedures concerning payment methods, and advising on pre-payment deposits and monthly payment plans. The representative is responsible for obtaining and documenting current funding information or providing details on available funding sources when patients lack them. This role requires close collaboration with all departments within the revenue cycle to address and resolve issues or barriers. The Financial Rep will also handle upfront collections for self-pay accounts, co-pays, deductibles, and co-insurance based on insurance information. Furthermore, the position involves screening patients for potential eligibility for third-party and charity programs, staying updated on insurance procedures, and utilizing payer resources and websites to verify eligibility and initiate referrals for programs like MediCal/CMS/CCS. The individual will administer Palomar Health's Financial Assistance Policy and Procedures to determine patient eligibility for discounted services or charity care, and must be knowledgeable about AB774 to assist patients in qualifying based on federal poverty guidelines. The role demands a careful financial evaluation of all admissions, prioritizing the hospital's best interests while showing proper consideration for the patient. The representative must be firm and decisive, yet courteous, tactful, considerate, and empathetic, especially during stressful situations. Effective communication with individuals from diverse educational backgrounds, keen observation, alertness, and the ability to make payment-related decisions amidst frequent interruptions are crucial. Proficiency in speaking and reading English is required to perform essential functions. The role also necessitates knowledge of standard office equipment (calculator, fax, photocopier) and personal computer skills, including MS Windows, Excel, Access, Word, PowerPoint, internet, and e-mail, with proficient keyboarding and mouse skills required upon employment or within the first two weeks.

Requirements

High School Diploma and/or combination of education and experience.
2 years Patient Access and/or Patient Financial Services experience assisting patients with insurance and government funded programs.
Speak and read English at a level that is sufficient to satisfactorily perform the essential functions of the position.
Knowledge of standard office equipment (i.e., calculator, fax, photocopier).
Personal computer and computer software skills (i.e., MS Windows, Excel, Access, Word, Powerpoint, internet, e-mail).
Windows computer skills including proficient use of keyboarding, use of mouse or keys for functions such as selecting items, use of drop down menus, scroll bars, opening folders, copying and similar operations required upon employment or within the 1st two weeks of employment.

Nice To Haves

1 year healthcare-related experience or basic college/medical coursework to learn medical terminology.
3+ years Patient Access and Patient Financial Services experience assisting patients with insurance and government funded programs, including experience related to billing and payment of government funded health plans.
Bilingual (Spanish).
Certified Healthcare Access Associate (NAHAM) or equivalent.

Responsibilities

Serve as the first contact for patients and families regarding funding sources for inpatient and outpatient services.
Obtain funding for patients in the statuses of scheduling, pre-registration, registration, or post registration as assigned.
Screen all admissions on a daily basis.
Educate referring physicians offices, patients and their families on hospital policy and procedures regarding various methods of payment source for services rendered.
Advise applicable admits of pre-payment deposits and monthly payment arrangements.
Obtain and document information that appropriately designates current funding information and/or provides information on available funding sources if the patient/family does not have current sources.
Work in collaboration with all departments and units in the revenue cycle to appropriately communicate issues and/or barriers, and to formulate work plans for resolution.
Obtain appropriate up front collection on all self pay accounts as well as co-pays, deductibles, and co-insurance as identified in information provided by the patient's insurance card or through the eligibility and verification process.
Screen the patient for possible other 3rd party and charity eligibility.
Keep up-to-date on admission/business office insurance procedures.
Utilize payer resources and web sites to accurately explore and assess eligibility and successfully initiate referrals for MediCal/CMS/CCS.
Appropriately administer the Palomar Health Financial Assistance Policy and Procedures to determine if the patient is eligible for discounted prices for services or is eligible for charity care designation.
Assist the patient/family in determining if they qualify based on federal poverty guidelines (AB774).
Perform careful financial evaluation of all admissions, taking appropriate steps that are most beneficial to the hospital, while giving the proper level of consideration to the patient.
Effectively communicate with people from various education backgrounds.
Make decisions regarding methods of payment.
Perform other duties as assigned.
Follow Palomar Health rules, policies, procedures, applicable laws and standards.
Carry out the mission, vision, and quality commitment of Palomar Health.