St. Francis Medical Center is one of the leading comprehensive healthcare institutions serving Southeast Los Angeles. St. Francis is dedicated to providing vital healthcare services for the 700,000 adults and 300,000 children who count on the hospital for high quality and compassionate medical care. St. Francis is recognized for its full range of diagnostic and treatment services in specialties including Cardiovascular, Surgical, Orthopedics, Maternal-Child Health, Behavioral Health and Emergency and Trauma Care.  In addition, the hospital offers a broad array of education and outreach programs that advance community health. St. Francis Medical Center is a Certified Primary Stroke Center, Approved STEMI Receiving Center for Los Angeles County and designated Baby-Friendly healthcare facility by Baby-Friendly USA. Please visit www.stfrancismedicalcenter.comfor more information.

Join an award-winning team of dedicated professionals committed to our core values of quality, compassion and community!

Why Prime Healthcare? St. Francis Medical Center, a member of Prime Healthcare, offers incredible opportunities to expand your horizons and be part of a community dedicated to making a difference.

St. Francis Medical Center offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs.

Our Total Rewards package includes, but is not limited to:

• Paid time off
• 401K retirement plan
• Outstanding Medical
• Dental
• Vision coverage
• Tuition reimbursement
• Many more voluntary benefit options!

Benefits may vary based on collective bargaining agreement requirements and/or the employment status, i.e. full-time or part-time.

We are an Equal Opportunity Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation, or other protected characteristics.  If you need special accommodation for the application process, please contact Human Resources.  Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf

Privacy Notice for California Applicants: https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf

The insurance verification /QC/ Financial counselor specialist must possess knowledge of the various payers i.e. commercial, Managed care, government plans and State programs, i.e. Medi-Cal/Medicaid and CCS.  The verifier/financial counselor is responsible for verifying patient insurance coverage, to ensure necessary procedures are covered by an individual’s provider. He/she is responsible for entering data in an accurate manner, as it is his/her job to update patient benefit information in the organization’s insurance system and verify that existing information is accurate. This position requires the individual to spend extensive amounts of time on the phone and /or insurance companies websites to ensure that all benefits have been verified for determination of authorization requirements.  This position also serves as a valuable resource to patients, providing them with pertinent information regarding their coverage. This position works with patients to explain coverage amounts provided by their insurance policy, so they can understand why some procedures may be covered, while others are not.  This position also assist patients with payment arrangement plans for services that are not covered by their insurance companies and/or for those self-pay patients.   Advises patients of any alternative sources of funding or assistance available from state and/or government agencies.  Calculates and collects cash packages by using Medicare DRG/APC reimbursement table.  Responsible for financially counseling patients at hospital bedside, OP registration and/or ER to obtain cash payment or determine eligibility for various governmental programs.  Set up arrangements / monthly installment agreements for patients to payoff balances within the guidelines of Prime Healthcare Systems collection policy.  Follows up on any self-pay patients that were missed within 3 days.  Work closely with Case Management (UR) daily in regards to patient status changes; whether this would include patient type or insurance notification or insurance coverage.   Must have excellent customer service and communication skills with the ability to effectively calm patients and be able to deal with distressed and/or agitated patients and their families.  This position is also responsible for the QC of all registered accounts in the department.  All accounts need to be corrected through the hospital QC computer system (AHIQA) and through the manual QC.  All data must be entered in the Manual QC folder found in the hospital SharePoint site.  This position must QC 100% of all inpatients, surgical accounts and 50% of outpatients and ER accounts.   

Education and Work Experience

1. Knowledge of standard insurance companies, i.e. PPO, HMO, EPO, and their verification requirements.
2. Knowledge of HPE, CCS programs eligibility and application process.
3. Well versed in authorization processes for all payers.
4. Ability to multi-task, prioritize needs to meet required timelines.
5. Analytical and problem-solving skills.
6. Customer Services experience required.
7. High School Graduate or GED equivalent required.

St. Francis Medical Center offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to, paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more voluntary benefit options. Benefits may vary based on collective bargaining agreement requirements and/or the employment status, i.e. full-time or part-time. The current compensation range for this role is $21.00 to $25.98. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.