Advanced Therapies Benefits Specialist (Financial Clearance)

Shields Advanced Therapies•Tampa, FL

19d•Onsite

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 is based in Tampa and is performed in the office five days per week. It reports to the SVP, Operations. The specialist investigates and verifies insurance coverage and benefits, facilitates prior authorizations, assists with benefit program enrollment when applicable, and counsels patients about coverage, out-of-pocket costs, and financial assistance. The role collaborates with clinical, patient accounting, billing and collections, research, managed care, payer access, and manufacturer teams to support financial clearance and access to treatment. The specialist also documents patient interactions and financial assistance in compliance with healthcare regulations and privacy laws, develops and executes benefits investigation and authorization pathways for advanced therapy products, supports Letters of Agreement or Single Case Agreements when needed, and contributes to establishing a centralized Benefits Specialist function for current and future health system partners.

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 to assist patients effectively.
Attention to detail and strong organizational abilities.
Proficiency with healthcare information systems.

Nice To Haves

Prior experience or familiarity with payer navigation for cellular therapy, including CAR T and TIL, gene therapy, and/or bone marrow transplant patient journeys and applicable prior authorizations.
Prior exposure to both inpatient and outpatient site-of-care settings.

Responsibilities

Investigate and verify patient insurance eligibility, coverage, and benefits with government and commercial payers, out-of-state Medicaid agencies, PBMs, and TPAs as early as possible in the care journey.
Confirm insurance plan details, including site-of-care considerations, to support timely access to care, accurate billing, and reduced claim denials.
Coordinate with patients, Cell & Gene Therapy Clinical Coordinators, clinical staff, and payers to obtain prior authorizations for applicable components of treatment plans.
Guide patients through enrollment in Medicaid, Medicare, and other applicable financial assistance or benefit programs, including helping with applications and explaining program requirements.
Explain insurance benefits, out-of-pocket costs, billing, site-of-care considerations, and available financial assistance to patients.
Collaborate with clinical staff, patient accounting, billing and collections, research, and other hospital departments; communicate benefit 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 patient information in compliance with applicable regulations and privacy laws.
Develop and execute benefits investigation and prior authorization pathways tailored to advanced therapy products across health system partner service lines and therapeutic programs.
Partner with Managed Care and Payer Access teams to secure Letters of Agreement or Single Case Agreements when needed to enable patient access to treatment.
Contribute to development of a centralized Benefits Specialist function supporting health system partners and future partners.