Cell & Gene Therapy Benefits Specialist

Shields Advanced Therapies • Tampa, FL

2d

About The Position

The Cell & Gene Therapy Benefits Specialist will play a crucial role in managing and coordinating patient financial services, ensuring that patients understand and can access available financial resources from payers, manufacturers, and foundations. The role will report to the Director, Clinical Operations. Core Responsibilities: Benefits Investigation & Verification: Work with all payers (Government, Commercial, and otherwise, including out-of-state Medicaid agencies), pharmacy benefit managers (PBMs) and third-party administrators (TPAs) to identify, investigate and verify patient insurance coverage and benefits as early as possible within the care journey to ensure timely access to care, accurate billing, and minimal claim denials. This involves confirming eligibility and understanding the specifics of various insurance plans, including site-of-care considerations. Prior Authorization Facilitation: Work with patient, Cell & Gene Therapy Clinical Coordinators, clinical staff, payer, and others to secure prior authorizations for each component of the treatment plan as applicable/required. Benefit Enrollment Assistance (if applicable): Guide patients through the process of enrolling in appropriate benefit programs, such as Medicaid, Medicare, or other financial assistance options. This may involve helping patients complete necessary applications and providing information on program requirements. Patient Financial Counseling: Assist patients in understanding their insurance benefits, out-of-pocket costs, and available financial assistance programs. This includes explaining coverage details and guiding patients through the complexities of healthcare billing, including site-of-care considerations. Collaboration with Departments: Work closely with clinical staff, patient accounting, billing & collections, and other hospital departments (e.g., research) to communicate benefits considerations and serve as point of contact during financial clearance process, ensure accuracy, and enhance patient satisfaction. This collaboration ensures that financial considerations are integrated into patient care planning. Collaboration with Manufacturers: In partnership with the Cell & Gene Therapy Clinical Coordinators, work with manufacturers to attempt securing additional financial assistance as applicable/appropriate. Compliance and Documentation: Maintain accurate records of patient interactions, financial agreements, and assistance provided, ensuring compliance with healthcare regulations and privacy laws. This includes documenting all financial counseling sessions and maintaining confidentiality of patient information. Development and Execution of Financial Pathways: Codify and execute benefits investigation and prior authorization pathways tailored to each product covered by advanced therapy programs across Health System Partner's service lines and therapeutic programs. Programmatic Expansion: Contribute to development of centralized Benefits Specialist function that will augment dedicated teams at our Health System Partners and other future partners.

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.
• Proficiency with healthcare information systems.

Nice To Haves

• 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.
• 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.
• Secure prior authorizations for treatment plan components.
• Guide patients through enrollment in benefit programs like Medicaid and Medicare.
• Assist patients in understanding insurance benefits, out-of-pocket costs, and financial assistance programs.
• Collaborate with clinical staff, patient accounting, billing & collections, and other hospital departments.
• Work with manufacturers to secure additional financial assistance.
• Maintain accurate records of patient interactions and financial agreements, ensuring compliance with regulations.
• Codify and execute benefits investigation and prior authorization pathways.
• Contribute to the development of a centralized Benefits Specialist function.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed