Tri-City Medical Center has served San Diego County’s coastal communities of Carlsbad, Oceanside and Vista, as well as the surrounding region for more than 60 years and is one of the largest employers in North San Diego County. Tri-City is administered by the Tri-City Healthcare District, a California Hospital District. As a full-service acute care public hospital with over 500 physicians practicing in over 60 specialties, Tri-City is vital to the well-being of our community and serves as a healthcare safety net for many of our citizens. The hospital has received a Gold Seal of Approval® from the Joint Commission showcasing a commitment to safe and effective patient care for the residents of the community. 

Tri-City Medical Center prides itself on being the home to leading orthopedic, spine and cardiovascular health services while also specializing in world-class robotic surgery, cancer and emergency care. Tri-City’s Emergency Department is there for your loved ones in their time of need and is highly regarded for our heart attack and stroke treatment programs. When minutes matter, Tri-City is your source for quality compassionate care close to home. Tri-City partners with over 90 local non-profit and community organizations as part of our COASTAL Commitment initiative. Together we are helping tackle some of our communities’ pressing health and social needs.

Position Summary:

Provides financial counseling to patients and families in accordance with the facility’s policies. Assists patients/families with financial arrangements, including financial assistance, for qualified patients, from outside agencies. 

Major Position Responsibilities:

The position characteristics reflect the most important duties, responsibilities and competencies considered necessary to perform the essential functions of the job in a fully competent manner. They should not be considered as a detailed description of all the work requirements of the position. The characteristics of the position and standards of performance may be changed by TCMC with or without prior notice based on the needs of the organization.

• Verifies patient’s eligibility and benefits with health plans and/or medical group for all in-patient and observation accounts. Re-verifies insurance benefits for all patients who remain in-house after thirty (30) days from admit and every thirty (30) days until discharge.
• Verifies that all inpatient accounts have the proper authorization, TAR’s, pre-certification and referral numbers in accordance with payer guidelines.
• Follows up with the utilization department when an authorization needs to have additional days or the need for continuation.
• Calculates the patient’s estimated responsibility using the insurance benefits and hospital contracts.
• Performs bedside visits to explain the estimated amount due and collects from patient or establishes a payment plan for estimated outstanding balance. Assists patients with referrals and completion of forms.
• Verifies eligibility on all Medi-Cal programs, County Medical Services (CMS) and CCS on inpatient admissions with-in one (1) day of business day of admission. Treatment Authorization Request (TAR) is necessary for Medi-Cal patients and works with the field office nurse to resolve account. Updates information necessary for discharge.
• Serves as a resource for hospital staff for answering Admitting-related questions. Will quickly educate and update the Admitting staff with information concerning changes/deviations to all applicable insurance programs.
• Correctly receipts payments and posts entries to the Cash Receipt Journal.
• Updates and maintains HRIF accounts.
• Interviews all cash accounts bedside for: Insurance coverage, ability to pay or if account needs to be referred and to outside agency for Government Program Assistance. The Financial Counselor may assist patients fill out forms for County and/or government programs. Patients with the ability to pay will be provided with an estimate and requested that full payment be made at the time of discharge. Any patient not able to pay in full will be provided with a payment plan.
• Reviews daily, all inpatient accounts requiring additional information and follows up until the patient is discharged.
• Will monitor patients with LOS greater than 7 days and accounts greater than 100k and note the system. Will provide information to supervisor on a weekly basis of the current benefits, outstanding amount owed by patient, and any possible issues with Authorization for the stay.
• Verify and correct all patient demographic and insurance data elements in Millenium and Quardramed systems to ensure a clear cross flow of information and to facilitate processing of payments.
• Obtain signatures on all forms necessary.
• Other duties as assigned by management.
• Department cross training for coverage of patient care.
• Takes personal initiative to bring forward process/performance improvements as identified.
• Performs special assigned duties to meet the needs of the department. 

Safety and Infection Control Responsibilities

• Responsible to maintain a safe and clean work environment, including unit based specific safety and infection control requirements.

Qualifications: ESSENTIAL COMPETENCIES, KNOWLEDGE, & EXPERIENCE

• Minimum of 3 years healthcare insurance experience.
• Knowledge of PPO, HMO, Medicare, Medi-Cal and other government agencies, required.
• Miniumum2 years of medical office/hospital insurance experience, required.
• 1-year data entry/CRT/PC experience, required.
• 1 year demonstrated working knowledge of medical terminology, required. 
• Bilingual, required.
• Excellent oral and written communication skills, required.
• Intermediate skills in Microsoft Word, Excel and Microsoft Outlook, required. 
• Excellent human relations’ skills including listening, conflict resolution, required.
• Must have ability to demonstrate flexibility in response to unexpected change in work volume and hospital staffing needs.
• Process oriented skills with ability to handle multiple projects simultaneously by prioritizing responsibilities and meeting deadlines, required.
• Ability to ensure the confidentiality and rights of patients and the confidentiality of hospital and departmental documents, required.
• Must understand the various patient payment agreements, required.   

Education:

• High school graduate or GED, required.

Each new hire candidate who is offered employment must pass a physical evaluation, urine drug screen and pre-employment background checks before starting work.

*Salary/Hourly Wage range based on experience.

To protect the health of patients and staff, and to comply with the new State of California mandates, all job offers are contingent on the successful engagement in the TCMC COVID-19 vaccination program (fully vaccinated with documented proof or approved exception/deferral.)

TCHD is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex (including pregnancy, sexual orientation, or gender identity/expression), age, marital status, status as a protected veteran, among other things, or status as a qualified individual with a disability.