Pre-Cert Coordinator

Astera•East Brunswick, NJ

1d•$25 - $29•Remote

About The Position

Responsible for collaborating with healthcare providers and members to optimize member benefits and to promote effective use of financial resources available. Assesses the medical necessity of chemotherapy treatment and non-chemotherapy treatment. Conducts pre-certification, concurrent and retrospective reviews to ensure compliance with medical policy, member eligibility, benefits, and patient’s financial capability. Remote position however will travel to East Brunswick location for meetings.

Requirements

High School Diploma required.
At least one year of experience in the medical insurance field, Hematology/Oncology/Urology preferred.
Prior work experience with insurance precertification and/or financial counseling is recommended.
Excellent verbal and written communication skills to verbally explain treatment plans with physicians and other staff, as well as explaining financial responsibilities to patients based on insurance verification outcomes.
Role involves frequent interaction with all levels of staff, physicians, patients and insurance companies.
Ability to multi-task and juggle multiple priorities in a fast-paced practice environment.
Must be well-organized and practice good time management skills.
Must have the ability to prioritize, make decisions and work independently in a remote work environment.
Knowledge of Hematology/Oncology/Urology practice operations preferred.
Knowledge of CPT-4, ICD-10, and HCPCS required.
This is a remote position within New Jersey.

Responsibilities

Performs pre-certification and related duties to secure authorization for payment for treatment from insurance companies, drug companies, foundation resources and patients.
Verification of patients’ benefits and eligibility for pre-certs
Verification that the diagnosis codes entered in the treatment plan are covered for the drug entered by comparing to insurance company policies and/or NCCN website.
Contacts with insurance company if treatment is approved for the diagnosis entered.
Entry of benefits provided by the insurance representative in Centricity (practice management system) along with the contact’s name and reference number for the call.
Once the benefits are verified, task the treatment scheduler, place treatment and expiration date in billing notes, note appointment note in OncoEMR (PC/GK).
Re-precertification of services, as necessary. It is the sole responsibility of this position to handle for all assigned areas.
Coordinate referral out for treatments if the situation dictates. Example: If a patient has Medicare only the pre-cert coordinator will get a mock bill of all charges that the patient would have in their cycle of treatment and calculated and relayed to the patient, if patient cannot afford the 20% of remaining bill the patient will be notified they should go to the hospital, the patient’s physician and pharmacist are notified to set up for the hospital.
Follow all policy and procedure set by Astera Cancer Care to correct any insurance issues before patient has treatment in the office.
Communication with patients regarding deductibles and out of pocket costs
Patient responsibility will be calculated during benefits verification/Pre-certification process.
If qualified, coordinate enrollment in drug programs, foundations, for assistance out of pocket costs for drugs, co-pays, etc.
Utilize online methods for enrollment, if at all possible, for greater efficiency.