Advanced Therapies Benefits Specialist (Financial Clearance)

Shields Advanced Therapies•Durham, NC

About The Position

The Advanced Therapies Benefits Specialist manages and coordinates patient financial services so patients understand and can access financial resources from payers, manufacturers, and foundations. The role investigates and verifies insurance coverage and benefits, facilitates prior authorizations, assists with benefit enrollment when applicable, and counsels patients on coverage, out-of-pocket costs, and financial assistance. It collaborates with clinical, hospital, payer, and manufacturer teams to integrate financial considerations into care planning and support timely access to treatment. The specialist maintains accurate and compliant documentation, develops and executes benefits investigation and prior authorization pathways for products across advanced therapy programs, and works with Managed Care and Payer Access teams on Letters of Agreement or Single Case Agreements when needed. The role also contributes to developing a centralized Benefits Specialist function for current and future health system partners. It is based in the Raleigh/Durham, North Carolina area, requires initial in-office training, and transitions to remote work after training. The position reports to the Service Access Manager, Financial Clearance.

Requirements

At least 5 years of experience in healthcare billing, insurance coordination, or patient financial counseling.
Familiarity with healthcare financial systems and insurance verification processes.
Strong communication and interpersonal skills.
Attention to detail and organizational abilities.
Proficiency with healthcare information systems.

Nice To Haves

Prior experience or familiarity with payer navigation for cellular therapy (such as CAR T or TIL), gene therapy, and/or bone marrow transplant patient journeys and applicable prior authorizations.
Prior exposure to both inpatient and outpatient sites of care.

Responsibilities

Investigate and verify patient insurance eligibility, coverage, and benefits with government and commercial payers, including out-of-state Medicaid agencies, pharmacy benefit managers, and third-party administrators.
Confirm plan details, including site-of-care considerations, early in the care journey to support timely access, accurate billing, and reduced claim denials.
Coordinate with patients, Cell & Gene Therapy Clinical Coordinators, clinical staff, payers, and others to secure required prior authorizations for treatment-plan components.
Guide patients through enrollment in applicable benefit programs, such as Medicaid, Medicare, and other financial assistance options, including assistance with applications and program requirements.
Explain insurance benefits, out-of-pocket costs, financial assistance options, and healthcare billing to patients.
Collaborate with clinical staff, patient accounting, billing and collections, research, and other hospital departments; communicate benefits considerations and serve as a point of contact during financial clearance.
Work with manufacturers, in partnership with the team, to seek additional financial assistance when appropriate.
Maintain accurate records of patient interactions, financial agreements, and assistance provided; document counseling sessions and protect confidential information in compliance with healthcare regulations and privacy laws.
Develop and execute benefits investigation and prior authorization pathways tailored to each covered advanced therapy product and partner health system service line or therapeutic program.
Partner with Managed Care and Payer Access teams to establish Letters of Agreement or Single Case Agreements when needed to enable patient access to treatment.
Contribute to developing a centralized Benefits Specialist function for existing and future health system partners.