Mount Sinai Health System · 18 hours ago

Cancer Center Therapeutic Pre Cert Counselor- Therapeutic Billing- 42nd Street-Full-Time Days

United States

Full-time

Remote

Entry Level

$30.33/hr - $30.33/hr

Maximize your interview chances

Health CareHospital

Actively Hiring

Insider Connection @Mount Sinai Health System

Discover valuable connections within the company who might provide insights and potential referrals.
Get 3x more responses when you reach out via email instead of LinkedIn.

Responsibilities

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 patients medical records to satisfy the payer authorization requirements.

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 patients 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 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.

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.

Qualification

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

Insurance verificationPrecertification experienceHospital billingMicrosoft WordMicrosoft ExcelEagle 2000CernerEpicOn-TracTypingData EntryPatient communication