trength Through Diversity
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Admitting Patient Accounting- Req # 80767
Cancer Center/Therapeutic Pre-Certification Counselor
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.
- Determines and verifies patient demographic and insurance information and updates all requires systems to ensure all have correct information.
- Identifies hospital visits/services which require a referral and obtains the required referral from the patient or referring provider.
- 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.
- As part of the authorization process, verify 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.
- When required, reached 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.
- Notify clinical team, scheduling team, and patient of any delays in financial clearance which might delay their treatment start date.
- Calculation of 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.
- Clearly communications 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.
- 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 responsibility.
- 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
- High School Diploma – Associate Degree preferred
- Prior insurance verification or precertification experience; or Hospital or Physicians Office billing experience required.
- Working knowledge of Microsoft Word, Excel, Internet and Outlook; Typing skills with a minimum of 35 words per minute; Knowledge of On-Trac, Eagle 2000, Cerner and Epic applications preferred.
- Individual must have the ability to set priorities, problem solves and use proper judgment in difficult situations and be flexible.
- Excellent written, oral communication, interpersonal and customer service skills required. Individual must be able to work independently and self-starter
- Bilingual preferred.
Strength Through Diversity
The Mount Sinai Health
System believes that diversity 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 medicine together.
We work hard to acquire and retain the best people, and to create a welcoming, nurturing work environment where you can develop professionally. We share the belief that all employees, regardless of job title or expertise, can make 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 hospital campuses, including Mount Sinai Beth Israel, Mount Sinai Beth Israel 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.