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

Cancer Center/Therapeutic Pre-Certification Counselor

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.

Responsibilities

1. Determines and verifies patient demographic and insurance information and updates all required 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.

Qualifications

• HS/GED; Associates Degree preferred
• Prior insurance verification or precertification experience; or Hospital or Physicians 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

About Us

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.

At Mount Sinai, our leaders are committed to fostering a workplace where all employees feel valued, respected, and empowered to grow. We strive to create an environment where collaboration, fairness, and continuous learning drive positive change, improving the well-being of our staff, patients, and organization. Our leaders are expected to challenge outdated practices, promote a culture of respect, and work toward meaningful improvements that enhance patient care and workplace experiences. We are dedicated to building a supportive and welcoming environment where everyone has the opportunity to thrive and advance professionally. Explore this opportunity and be part of the next chapter in our history.

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 hospitals, more than 400 outpatient practices, more than 300 labs, a school of nursing, and a leading school of medicine and graduate education. Mount Sinai advances health for all people, everywhere, by taking on the most complex health care challenges of our time discovering and applying new scientific learning and knowledge; developing safer, more effective treatments; educating the next generation of medical leaders and innovators; and supporting local communities by delivering high-quality care to all who need it. Through the integration of its hospitals, labs, and schools, Mount Sinai offers comprehensive health care solutions from birth through geriatrics, leveraging innovative approaches such as artificial intelligence and informatics while keeping patients' medical and emotional needs at the center of all treatment. The Health System includes more than 9,000 primary and specialty care physicians; 13 joint-venture outpatient surgery centers throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and more than 30 affiliated community health centers. We are consistently ranked by U.S. News & World Report's Best Hospitals, receiving high "Honor Roll" status, and are highly ranked: No. 1 in Geriatrics, top 5 in Cardiology/Heart Surgery, and top 20 in Diabetes/Endocrinology, Gastroenterology/GI Surgery, Neurology/Neurosurgery, Orthopedics, Pulmonology/Lung Surgery, Rehabilitation, and Urology. New York Eye and Ear Infirmary of Mount Sinai is ranked No. 12 in Ophthalmology. U.S. News & World Report's "Best Children's Hospitals" ranks Mount Sinai Kravis Children's Hospital among the country's best in several pediatric specialties. The Icahn School of Medicine at Mount Sinai is ranked No. 11 nationwide in National Institutes of Health funding and in the 99th percentile in research dollars per investigator according to the Association of American Medical Colleges. Newsweek's "The World's Best Smart Hospitals" ranks The Mount Sinai Hospital as No. 1 in New York and in the top five globally, and Mount Sinai Morningside in the top 20 globally.

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 the communities we serve feel respected and supported. Our goal is to create a healthcare and learning institution that actively works to remove barriers, address challenges, and promote fairness in all aspects of our organization.

Job Info

• Job Identification 3036758
• Job Category Professional
• Job Schedule Full time
• Job Shift Day
• Locations 150 E 42nd St, New York, NY, 10017, US