Benefits Specialist Jobs

About The Position

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.