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 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 Determines and verifies patient demographic and insurance information and updates all required systems to ensure all have correct information. Identifies hospital visits/services which require a referral and obtains the required referral from provider. Obtains authorization for all services, procedures, and treatments being provided in the Centers, prior to the requested treatment start date. Authorizations are obtained online via the payer/vendor web portal when available or via phone/fax. As part of the authorization process, verifies medical necessity of the CPT/HCPCS codes being ordered via the CMS or payer website, or via the drug website. Off‑label treatments are 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 patient’s co‑pay, co‑insurance and/or deductible for the services being rendered/requested and notifies the patient of their self‑pay responsibility prior to the treatment start date. For eligible patients, refers the patient to applicable resources. Clearly communicates to the patient their financial obligations prior to treatment and answers any questions regarding the billing process or refers the patient 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 response. Is 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. Qualifications HS/GED; Associate Degree preferred. Prior insurance verification or precertification experience; or hospital or physician’s office billing experience required. 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. Compensation The salary range for the role is $31.3956 - $31.9289 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. #J-18808-Ljbffr Mount Sinai Morningside