Advanced Therapies Financial Coordinator
About The Position
Shields Advanced Therapies partners with academic medical centers and pharmaceutical companies to build the infrastructure needed to bring advanced therapies to more patients. The Advanced Therapies Benefits Specialist coordinates patient financial services so patients understand and can access financial resources available through payers, manufacturers, and foundations. This is a full-time role based in the Raleigh/Durham, North Carolina area. It requires initial in-office training, followed by a transition to remote work after training is completed. The role reports to the Service Access Manager, Financial Clearance. The position involves investigating and verifying insurance benefits, facilitating prior authorizations, assisting with benefit-program enrollment and patient financial counseling, and coordinating with clinical, hospital, payer, and manufacturer teams. The employee will document interactions and assistance in compliance with healthcare regulations and privacy laws, develop and execute product-specific financial pathways, support Letters of Agreement or Single Case Agreements when needed, and contribute to the expansion of a centralized Benefits Specialist function.
Requirements
- Five or more 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 (CAR T, TIL, etc.), gene therapy, and/or bone marrow transplant patient journeys and related prior authorizations.
- 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 insurance-plan details, including site-of-care considerations, as early as possible in the care journey to support timely access, accurate billing, and fewer 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, or other applicable benefit and financial assistance programs, including helping with applications and explaining program requirements.
- Explain insurance benefits, out-of-pocket costs, billing, and available financial assistance options 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 while complying with healthcare regulations and privacy laws and protecting patient confidentiality.
- Develop and execute benefits investigation and prior authorization pathways for each product across Health System Partner service lines and therapeutic programs.
- Partner with Managed Care and Payer Access teams to establish Letters of Agreement or Single Case Agreements when needed to facilitate patient access to treatment.
- Contribute to developing a centralized Benefits Specialist function that augments dedicated teams at Health System Partners and future partners.
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What This Job Offers
Job Type
Full-time
Education Level
No Education Listed
