Advanced Therapies Benefits Specialist
About The Position
Shields Advanced Therapies was created to solve the challenge of bringing breakthrough treatments to more patients by partnering with leading academic medical centers and pharmaceutical companies to build the necessary infrastructure. The company is led by a seasoned leadership team and is grounded in Shields' longstanding commitment to culture, hospital partnership, and delivering better patient care at the lowest possible cost. Shields Advanced Therapies is anchored by 8 of the Top 20 Academic Medical Centers in the United States, and Shields' 40+ year track record of partnering with over 1,000 hospitals across 43 states provides a natural channel for continued expansion.
Requirements
- 5+ years of experience in healthcare billing, insurance coordination, or patient financial counseling.
- Familiarity with healthcare financial systems and the insurance verification process.
- Strong communication and interpersonal skills.
- Attention to detail, organizational abilities, and proficiency with healthcare information systems.
- Prior experience/familiarity with payer navigation specifically related to cellular therapy (CAR T, TIL, etc.), gene therapy, and/or bone marrow transplant patient journeys and applicable prior authorizations.
Nice To Haves
- Prior exposure with both inpatient & outpatient site-of-care.
Responsibilities
- Identify, investigate, and verify patient insurance coverage and benefits with all payers, PBMs, and TPAs to ensure timely access to care, accurate billing, and minimal claim denials.
- Confirm eligibility and understand the specifics of various insurance plans, including site-of-care considerations.
- Secure prior authorizations for each component of the treatment plan by working with patients, clinical staff, payers, and others.
- Assist patients in understanding their insurance benefits, out-of-pocket costs, and available financial assistance programs, including explaining coverage details and guiding them through healthcare billing complexities.
- Collaborate with clinical staff, patient accounting, billing & collections, and other hospital departments to communicate benefits considerations, serve as a point of contact during financial clearance, ensure accuracy, and enhance patient satisfaction.
- Partner with manufacturers to attempt to secure additional financial assistance as applicable/appropriate.
- Maintain accurate records of patient interactions, financial agreements, and assistance provided, ensuring compliance with healthcare regulations and privacy laws.
- Codify and execute benefits investigation and prior authorization pathways tailored to each product covered by advanced therapy programs.
- Partner with Managed Care and Payer Access teams to solidify agreements that ensure patient access when Letters of Agreement or Single Case Agreements are needed.
- Contribute to the development of a centralized Benefits Specialist function to augment dedicated teams at Health System Partners and other future partners.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
