Pre-Cert Coordinator

For us, what matters most is excellence. We are caring professionals, people who live, work and dedicate themselves to the communities within New Jersey and Pennsylvania. As such, we strive to provide a sanctuary of excellence, precision, thoroughness and genuine compassion. We also take a whole-person approach to patient care and treatment, tailoring all that we do around their unique needs.

And we do all we can for patients, going the extra mile to see that they’re supported, informed and getting the one-on-one care and service they deserve.

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. Remote position however will travel to East Brunswick location for meetings.

Performs pre-certification and related duties to secure authorization for payment for treatment from insurance companies, drug companies, foundation resources and patients.

• 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. Example:
  If a patient has Medicare only the pre-cert coordinator will get a mock bill of all charges that the patient would have in their cycle of treatment and calculated and relayed to the patient, if patient cannot afford the 20% of remaining bill the patient will be notified they should go to the hospital, the patient’s physician and pharmacist are notified to set up for the hospital.

• Follow all policy and procedure set by Astera Cancer Care to correct any insurance issues before patient has treatment in the office.

• 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 enrollment, if at all possible, for greater efficiency.

• The above statements are intended to be a representative summary of the major duties and responsibilities performed by the Pre-cert Coordinator. The staff member filling this role may be requested to perform job-related tasks other than those stated in this description.

• High School Diploma required.
• At least one year of experience in the medical insurance field, Hematology/Oncology/Urology preferred.
• Prior work experience with insurance precertification and/or financial counseling is recommended.
• Excellent verbal and written communication skills to verbally explain treatment plans with physicians and other staff, as well as explaining financial responsibilities to patients based on insurance verification outcomes.
• Role…