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JOB DESCRIPTION

Cancer Center Therapeutic Pre-Certification Counselor -Oncology Patient Financial Services- Full-Time Days- 42nd Street

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 requires systems to ensure all have correct information. 2.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 to be 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 web site, or via the drug website. Off-label treatments need to be 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 notify the patient of their self-pay responsibility prior to the treatment start date. For eligible patients, refer the patient information

• 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

• 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

• 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

• Schedule is varied to meet the needs of the service sites and ancillary departments. 14.Special projects as assigned by supervisor or manager

QUALIFICATIONS

Collective bargaining unit: SEIU 1199-MSBI

• HS/GED; Associates Degree preferred

• Prior insurance verification or precertification experience; or Hospital or Physicians Office billing experience required.

• Microsoft Word and Excel, Eagle 2000, CERNER, EPIC, and / or On-Trac experience preferred

• Successful candidate will be required to pass assessment test. (Typing and Data Entry)

SEIU 1199 at Mount Sinai Beth Israel and MS Downtown, AKS - Chemotherapy Suite - USD, Union Square - Downtown

ABOUT US

Strength Through Diversity

The Mount Sinai Health System believes that diversity, equity, and inclusion are key drivers for excellence. We share a common devotion to delivering exceptional patient care. 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 invite you to participate actively as a part of the Mount Sinai Health System team by:

• Using a lens of equity in all aspects of patient care delivery, education, and research to promote policies and practices to allow opportunities for all to thrive and reach their potential.

• Serving as a role model confronting racist, sexist, or other inappropriate actions by speaking up, challenging exclusionary organizational practices, and standing side-by-side in support of colleagues who experience discrimination.

• Inspiring and fostering an environment of anti-racist behaviors among and between departments and co-workers.

At Mount Sinai, our leaders strive to learn, empower others, and embrace change to further advance equity and improve the well-being of staff, patients, and the organization. We expect our leaders to embrace anti-racism, create a collaborative and respectful environment, and constructively disrupt the status quo to improve the system and enhance care for our patients. We work hard to create an inclusive, welcoming and nurturing work environment where all feel they are valued, belong and are able to advance professionally.

Explore more about this opportunity and how you can help us write a new 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 43,000 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 approximately 7,400 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 and top 20 in Cardiology/Heart Surgery, 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. 14 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.

The Mount Sinai Health System is an equal opportunity employer. We comply with applicable Federal civil rights laws and does not discriminate, exclude, or treat people differently on the basis of race, color, national origin, age, religion, disability, sex, sexual orientation, gender identity, or gender expression. We are passionately committed to addressing racism and its effects on our faculty, staff, students, trainees, patients, visitors, and the communities we serve. Our goal is for Mount Sinai to become an anti-racist health care and learning institution that intentionally addresses structural racism.”

EOE Minorities/Women/Disabled/Veterans

Requisition ID : 3017464