Cancer Center Therapeutic Pre Cert Counselor- Chemotherapy Suite - Union Square- 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

1.Determines and verifies patient demographic and insurance information and updates all requires systems to ensure all have correct information. 2.Identifies hospital visits/services which require a referral and obtains the required referral from provider

3.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.

4.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

5.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.

6.Notifies clinical team, scheduling team, and patient of any delays in financial clearance which might delay their treatment start date.

7.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

8.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

9.When applicable, refers patient over to the Medicaid Application Team so they can assist patient with obtaining insurance coverage. 10.Utilizes Epic, Cerner, IDX, Eagle, and the On-Trac system to document financial clearance status and patient respons

11.Cross-trained to support all service lines, treatments, and payers. 12.Remains up to date on all new treatment plans and drugs and what is required to financially clear these new treatments

13.Schedule is varied to meet the needs of the service sites and ancillary departments. 14.Special projects as assigned by supervisor or manager

14.Special projects as assigned by supervisor or manager

• 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

Compensation Statement

The Mount Sinai Health System (MSHS) provides salary ranges that comply with the New York City Law on Salary Transparency in Job Advertisements. The salary range for the role is $31.40 - $31.93 Hourly. Actual salaries depend on a variety of factors, including experience, education, and operational need. The salary range or contractual rate listed does not include bonuses/incentive, differential pay or other forms of compensation or benefits.

SEIU 1199 at Mount Sinai Beth Israel and MS Downtown, AKS - Chemotherapy Suite - USD, Union Square - Downtown

Strength through Unity and Inclusion

The Mount Sinai Health System is committed to fostering an environment where everyone can contribute to excellence. We share a common dedication to delivering outstanding patient care. When you join us, you become part of Mount Sinai’s unparalleled legacy of achievement, education, and innovation as we work together to transform healthcare. We encourage all team members to actively participate in creating a culture that ensures fair access to opportunities, promotes inclusive practices, and supports the success of every individual.

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About the Mount Sinai Health System:

Mount Sinai Health System is one of the largest academic medical systems in the New York metro area, with more than 48,000 employees working across eight hosp