Advanced Therapies Benefits Specialist (Financial Clearance)

Job Description

Job Description

About the Company

Advanced therapies represent one of the most significant shifts in modern healthcare, yet health systems face substantial operational, clinical, and financial barriers to adoption.

Shields Advanced Therapies was created to solve this challenge, partnering with leading academic medical centers and pharmaceutical companies to build the infrastructure necessary to bring these breakthrough treatments to more patients.

The company is led by a seasoned leadership team and is grounded in Shields' longstanding commitment to culture, hospital partnership, and delivering better patient care at the lowest possible cost.

Today, Shields Advanced Therapies is anchored by 8 of the Top 20 Academic Medical Centers in the United States and Shields' 40+ year track record of partnering with over 1,000 hospitals across 43 states provides a natural channel for continued expansion.

 

Role Overview

The Advanced Therapies 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 role based in Houston (5 days/week in office) reporting to the SVP, 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 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.

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 , work with manufacturers to attempt to secure 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.
• 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.

Programmatic Expansion

• Contribute to development of centralized Benefits Specialist function that will augment dedicated teams at our Health System Partners and other future partners.

 

Credentials & Requirements

• Ideal candidate will have 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

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