Cancer Center Therapeutic Pre Cert Counselor- Chemotherapy Suite - Union Square- Full Time Days

Mount Sinai Health System•New York, NY

2d•$31 - $32•Onsite

About The Position

The Cancer Center/Therapeutic pre-certification counselor is responsible for insurance verification, obtaining authorization for all services, and calculation and patient notification of co-insurance, co-payments and deductible for all treatment plans and services provided for patients of the Cancer Center and Therapeutic Programs.

Requirements

HS/GED; Associates Degree preferred
Prior insurance verification or precertification experience; or Hospital or Physician’s Office billing experience required.
Collective bargaining unit: SEIU 1199-MSBI

Responsibilities

Determines and verifies patient demographic and insurance information and updates all requires systems to ensure all have correct information.
Identifies hospital visits/services which require a referral and obtains the required referral from provider.
Obtains authorization for all services, procedures, and treatments being provided in the Centers, prior to the requested treatment start date. Authorizations are to be obtained online via the payer/vendor web portal when available or via phone /fax.
As part of the authorization process, verifies medical necessity of the CPT/HCPCS codes being ordered via the CMS or payer web site, or via the drug website. Off-label treatments need to be identified prior to treatment being started.
When required, reaches out to the clinical team to obtain a letter of medical necessity which might be required to obtain an authorization for the services/treatments being requested.
Notifies clinical team, scheduling team, and patient of any delays in financial clearance which might delay their treatment start date.
Calculates the patient’s co-pay, co-insurance and/or deductible for the services being rendered/requested and notify the patient of their self-pay responsibility prior to the treatment start date. For eligible patients, refer the patient information.
Clearly communicates to the patient their financial obligations prior to treatment and answers any questions they might have regarding the billing process or refers the patients to a Supervisor for assistance.
When applicable, refers patient over to the Medicaid Application Team so they can assist patient with obtaining insurance coverage.
Utilizes Epic, Cerner, IDX, Eagle, and the On-Trac system to document financial clearance status and patient respons.
Cross-trained to support all service lines, treatments, and payers.
Remains up to date on all new treatment plans and drugs and what is required to financially clear these new treatments.
Schedule is varied to meet the needs of the service sites and ancillary departments.
Special projects as assigned by supervisor or manager.