Cell & Gene Therapy Benefits Specialist

Job Description

Job Description

About Shields Advanced Therapies Shields Advanced Therapies partners with health systems to accelerate advanced therapy access and operations, ensuring life-changing breakthroughs reach more patients. Our management services and technology solutions serve as a horizontal support hub to empower health system- led, world-class advanced therapy care across 50+ disease states. Launched in September 2024, Shields Advanced Therapies is anchored by partnerships with five of the Top 20 Academic Medical Centers in the United States. Additionally, Shields' track record partnering with over 1,000 hospitals across 43 states in prior ventures provides a national channel for expansion. Role Overview 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. Experience:

• The ideal candidate will have 5+ years of experience in healthcare billing, insurance coordination, or patient financial counseling, and familiarity with healthcare financial systems and the insurance verification process.
• Strong communication and interpersonal skills are crucial for effectively assisting patients, and 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.