[Hiring] Financial Counselor/Pre-Cert Coordinator @Astera

Role Description

Responsible for collaborating with healthcare providers and members to optimize member benefits and to promote effective use of financial resources available. Assesses the medical necessity of chemotherapy treatment and non-chemotherapy treatment. Conducts pre-certification, concurrent and retrospective reviews to ensure compliance with medical policy, member eligibility, benefits, and patient’s financial capability. This position is remote within New Jersey.

• Performs pre-certification and related duties to secure authorization for payment for treatment from insurance companies, drug companies, foundation resources, and patients. Oncology experience a plus.
• Verification of patients’ benefits and eligibility for pre-certs.
• Verification that the diagnosis codes entered in the treatment plan are covered for the drug entered by comparing to insurance company policies and/or NCCN website.
• Contacts with insurance company if treatment is approved for the diagnosis entered.
• Entry of benefits provided by the insurance representative in Centricity (practice management system) along with the contact’s name and reference number for the call.
• Once the benefits are verified, task the treatment scheduler, place treatment and expiration date in billing notes, note appointment note in OncoEMR (PC/GK).
• Re-precertification of services, as necessary. It is the sole responsibility of this position to handle for all assigned areas.
• Coordinate referral out for treatments if the situation dictates.
• Follow all policy and procedure set by Astera Cancer Care to correct any insurance issues before patient has treatment in the office.
• Communication with patients regarding deductibles and out of pocket costs.
• Patient responsibility will be calculated during benefits verification/pre-certification process.
• If qualified, coordinate enrollment in drug programs, foundations, for assistance out of pocket costs for drugs, co-pays, etc.
• Utilize online methods for enrollments for greater efficiency.

Qualifications

• High School Diploma required.
• At least one year of experience in the medical insurance field, Oncology preferred.
• Prior work experience with insurance precertification and/or financial counseling.
• Knowledge of Hematology/Oncology practice operations preferred.
• Knowledge of CPT-4, ICD-10, and HCPCS required.
• Computer proficiency including the ability to utilize software programs used by the organization: Candid, G4/Centricity, Flatiron/OncoEMR, Annexus/Assistpoint, insurance websites.

Requirements

• This position is remote within New Jersey.

Benefits

• Comprehensive benefit package and paid time off.
• Immediate eligibility for medical, dental, vision, life, disability, HSA, FSA, and other ancillary benefits.
• 401(k) plan with company contribution.
• Profit sharing.
• Tuition assistance.
• Employee referral bonus.