Cancer Center Therapeutic Pre Cert Counselor- Oncology Billing- 42nd Street-Full-Time -Days

Cancer Center Therapeutic Pre Cert Counselor- Oncology Billing- 42nd Street-Full-Time -Days

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.

• 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 the patient or referring 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. This process will include extracting orders and clinical information from the patients medical records to satisfy the payer authorization requirements.
• 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 patients 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 over to the Co-Pay Assistance Team to see if the patient is eligible for any financial assistance from a foundation or drug company.
• 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 responsibility.
• 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

 

• HS/GED; Associates Degree preferred
• Prior insurance verification or precertification experience; or Hospital or Physicians Office billing experience required.
• Microsoft Word and Excel, Eagle 2000, CERNER, EPIC, and / or On-Trac experience preferred
• Successful candidate will be required to pass assessment test. (Typing and Data Entry)

 

Collective bargaining unit: SEIU 1199-MSH

 

SEIU 1199 at Mount Sinai Hospital, 518 - PFS 633 Third Avenue - MSH, Mount Sinai Hospital

Strength Through Diversity

The Mount Sinai Health System believes that diversity, equity, and inclusion are key drivers for excellence. We share a common devotion to delivering exceptional patient care. When you join us, you become a part of Mount Sinai’s unrivaled record of achievement, education, and advancement as we revolutionize medicine together. We invite you to participate actively as a part of the Mount Sinai Health System team by:  

• Using a lens of equity in all aspects of patient care delivery, education, and research to promote policies and practices to allow opportunities for all to thrive and reach their potential.
• Serving as a role model confronting racist, sexist, or other inappropriate actions by speaking up, challenging exclusionary organizational practices, and standing side-by-side in support of colleagues who experience discrimination.
• Inspiring and fostering an environment of anti-racist behaviors among and between departments and co-workers.

At Mount Sinai, our leaders strive to learn, empower others, and embrace change to further advance equity and improve the well-being of staff, patients, and the organization.  We expect our leaders to embrace anti-racism, create a collaborative and respectful environment, and constructively disrupt the status quo to improve the system and enhance care for our patients. We work ha