Advanced Therapies Benefits Specialist

Shields Advanced Therapies•Los Angeles, CA

4d•$65,000 - $85,000•Hybrid

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. This is a full-time, hybrid role based in Los Angeles (4 days/week in office) reporting to the Director, Clinical Operations.

Requirements

5+ years of experience in healthcare billing, insurance coordination, or patient financial counselling
Familiarity with healthcare financial systems and the insurance verification process required
Strong communication and interpersonal skills are crucial for effectively assisting patients
Attention to detail, organizational abilities, and proficiency with healthcare information systems are also important
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 required to enable is preferred
Prior exposure with both inpatient & outpatient site-of-care also preferred but not required

Responsibilities

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.
Work with patients, Cell & Gene Therapy Clinical Coordinators, clinical staff, payers, and others to secure prior authorizations for each component of the treatment plan as applicable/required.
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.
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.
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.
In partnership with the , work 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. This includes documenting all financial counseling sessions and maintaining confidentiality of patient information.
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.
Where Letters of Agreement or Single Case Agreements are needed to ensure access, partner with Managed Care and Payer Access teams to solidify agreements that get patients to treatment.
Contribute to development of centralized Benefits Specialist function that will augment dedicated teams at our Health System Partners and other future partners.