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

Job Description The Cancer Center/Therapeutic pre-certification counselor is responsible for insurance verification, obtaining authorization for all services, and calculation & 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. Qualifications HS/GED; Associate's Degree preferred. Prior insurance verification or pre‑certification experience; or hospital or physician’s office billing experience required. Collective bargaining unit: SEIU 1199-MSBI SEIU 1199 at Mount Sinai Beth Israel and MS Downtown, AKS — Chemotherapy Suite — USD, Union Square — Downtown Responsibilities Determine and verify patient demographic and insurance information and update all required systems to ensure correct information. Identify hospital visits/services which require a referral and obtain the required referral from provider. Obtain authorization for all services, procedures, and treatments 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. Verify medical necessity of the CPT/HCPCS codes being ordered via the CMS or payer website, or drug website; off‑label treatments must be identified before treatment starts. When required, reach out to the clinical team to obtain a letter of medical necessity which might be required to obtain authorization for the services/treatments requested. Notify clinical team, scheduling team, and patient of any delays in financial clearance that might delay their treatment start date. Calculate patient’s co‑pay, co‑insurance and/or deductible for the services being rendered/requested and notify the patient of self‑pay responsibility prior to the treatment start date; for eligible patients, refer them to information. Clearly communicate to the patient their financial obligations prior to treatment and answer any questions regarding the billing process; or refer the patients to a Supervisor for assistance. When applicable, refer patient over to the Medicaid Application Team so they can assist patient with obtaining insurance coverage. Utilize Epic, Cerner, IDX, Eagle, and the On‑Trac system to document financial clearance status and patient response. Cross‑train to support all service lines, treatments, and payers. Remain 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 needs of service sites and ancillary departments. Special projects as assigned by supervisor or manager. Equal Opportunity Employer The Mount Sinai Health System is an equal opportunity employer, complying with all applicable federal civil rights laws. We do not discriminate, exclude, or treat individuals differently based on race, color, national origin, age, religion, disability, sex, sexual orientation, gender, veteran status, or any other characteristic protected by law. We are deeply committed to fostering an environment where all faculty, staff, students, trainees, patients, visitors, and communities feel respected and supported. Compensation Statement Mount Sinai Health System (MSHS) provides a salary range to comply with the New York City Law on Salary Transparency in Job Advertisements. The salary range for the role is $31.3956 – $31.9289 hourly. Actual salaries depend on a variety of factors, including experience, education, and hospital need. The salary range or contractual rate listed does not include bonuses/incentive, differential pay or other forms of compensation or benefits. #J-18808-Ljbffr Mount Sinai Health System