Strength Through Diversity
Ground breaking science. Advancing medicine. Healing made personal.
Roles & Responsibilities:
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.
Duties and Responsibilities:
1. 1. Determines and verifies patient demographic and insurance information and updates all requires systems to ensure all have correct information.
2. 2. Identifies hospital visits/services which require a referral and obtains the required referral from the patient or referring provider.
3. 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. This process will include extracting orders and clinical information from the patient’s medical records to satisfy the payer authorization requirements.
4. 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. 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. 6. Notifies clinical team, scheduling team, and patient of any delays in financial clearance which might delay their treatment start date.
7. 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 over to the Co-Pay Assistance Team to see if the patient is eligible for any financial assistance from a foundation or drug company.
8. 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. 9. When applicable, refers patient over to the Medicaid Application Team so they can assist patient
with obtaining insurance coverage.
HS/GED; Associates degree preferred
Prior insurance verification or pre-certification experience; or Hospital or Physicians Office billing experience required.
Strength Through Diversity
The Mount Sinai Health System believes that diversity and inclusion is a driver for excellence. We share a common devotion to delivering exceptional patient care. Yet we’re as diverse as the city we call home- culturally, ethically, in outlook and lifestyle. When you join us, you become a part of Mount Sinai’s unrivaled record of achievement, education and advancement as we revolutionize healthcare delivery together.
We work hard to recruit and retain the best people, and to create a welcoming, nurturing work environment where you have the opportunity and support to develop professionally. We share the belief that all employees, regardless of job title or expertise, have an impact on quality patient care.
Explore more about this opportunity and how you can help us write a new chapter in our story!
Who We Are
Over 38,000 employees strong, the mission of the Mount Sinai Health System is to provide compassionate patient care with seamless coordination and to advance medicine through unrivaled education, research, and outreach in the many diverse communities we serve.
Formed in September 2013, The Mount Sinai Health System combines the excellence of the Icahn School of Medicine at Mount Sinai with seven premier hospitals, including Mount Sinai Beth Israel, Mount Sinai Brooklyn, The Mount Sinai Hospital, Mount Sinai Queens, Mount Sinai West (formerly Mount Sinai Roosevelt), Mount Sinai St. Luke’s, and New York Eye and Ear Infirmary of Mount Sinai.
The Mount Sinai Health System is an equal opportunity employer. We promote recognition and respect for individual and cultural differences, and we work to make our employees feel valued and appreciated, whatever their race, gender, background, or sexual orientation.