Advanced Therapies Benefits Specialist (Financial Clearance)

Shields Advanced Therapies; Los Angeles (CA); On-site; USD 65,000 - 85,000; Full time

Job summary

Shields Advanced Therapies is hiring a Cell & Gene Therapy Benefits Specialist in Los Angeles. This full-time, hybrid role involves managing patient financial services to ensure access to treatments.

The ideal candidate will assist patients with insurance benefits, prior authorizations, and financial counseling. A competitive salary ranging from $65,000 to $85,000 per year is offered, along with comprehensive benefits.

Qualifications

• 5+ years of experience in healthcare billing or insurance coordination.
• Familiarity with healthcare financial systems and insurance verification.
• Strong communication and interpersonal skills.

Responsibilities

• Manage financial services to ensure patient access to treatments.
• Facilitate prior authorizations for treatment plans.
• Assist patients in understanding insurance benefits and costs.

Skills

Healthcare billing

Insurance coordination

Patient financial counseling

Communication skills

Attention to detail

Organizational abilities

Job description

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.

This is a full‑time, hybrid role based in Los Angeles (4 days/week in office) reporting 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.
• 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.
• 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, including 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, explaining coverage details and guiding patients through the complexities of healthcare billing.
• Collaboration with Departments: Work closely with clinical staff, patient accounting, billing & collections, and other hospital departments (e.g., research) to communicate benefits considerations, serve as the point of contact during the financial clearance process, ensure accuracy, and enhance patient satisfaction.
• 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.
• 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; 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.

Compensation

Competitive base salary with bonus opportunity tied to outcomes metrics, with comprehensive benefits coverage also offered.

Salary: $65,000 - $85,000 per year