Biologics Coordinator (Practice)

Description

The Biologics Coordinator will assure the procedure for proper billing of biologics is followed according to Allergy Partners biologics billing guidelines. Duties include but are not limited to establishing specialized rebate and discount program participation, reviewing biologics charges prior to being submitted to insurance, provide follow-up and training as well as process improvement and communication to the Central Billing Office as well as the hubs. General oversight of centralized prior authorizations and re-certifications as well as assist with guidance to hubs related to patient assistance programs and education. Remain in compliance with insurance guidelines and Allergy Partners biologics policy and procedures.

Responsibilities include, but are not limited to, the following:

• Initiating of Specialty pharmacy medication and assisting in reordering, along with initiating/maintaining prior authorizations through specialty pharmacy vendors, coordinating copay card information with drug manufacturer and the patient, and communication of pharmacy benefits with the patient.
• Initiating of drug assistance (free drug) program medication and assisting in reordering.
• Maintaining physical patient stock of all biologic medications in office (BNB, specialty pharmacy, etc.) and communicating with the central corporate biologics team when stock is low or any issues with stock.
• Work closely with hub personnel and centralized Biologics Team to ensure that all biologics billing is entered into database(s) according to Allergy Partners guidelines.
• Efficiently obtain information from account reimbursement specialists, practice managers, and insurance companies to identify changes in billing guidelines.
• Become well versed on biologics billing as well as becoming familiar with different insurance payers limitations, exclusions, or other restrictions.
• Provide general oversight of prior authorization process as well as re-certification.
• Identify issues promptly and communicate to appropriate stakeholders.
• Audit accuracy of clinical documentation and claims.

• Complete ad-hoc projects and other duties as requested by the Practice Manager.

Other

• Maintains patient confidentiality, complies with HIPAA and compliance guidelines established by the practice by keeping information confidential.

• Maintains detailed knowledge of EHR, Practice Management systems and other platforms as it relates to job functions.
• Attends OSHA, HIPAA, and OIG training programs as required.
• Attends all meetings as requested including regular staff meetings.

• Performs any additional duties as requested by the Practice Manager.

Supervisory Responsibilities

This job has no supervisory responsibilities.

Typical Physical Demands

Position requires prolonged sitting, some bending, stooping, and stretching. Good eye-hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator, and other office equipment is also required. Employee will occasionally be asked to lift and carry items weighing up to 30 pounds. Employee must have normal range of hearing and eyesight to record, prepare, and communicate appropriate documents.

Typical Working Conditions

Employee will have potential exposure to communicable diseases, toxic substances, needle sticks and other conditions common to a clinic environment. Occasional evening or weekend work.

Qualifications

EDUCATIONAL REQUIREMENTS:

• High school diploma required.

QUALIFICATIONS AND EXPERIENCE

• Three to five years of experience, preferably in a healthcare setting.
• Excellent communication skills, both written and oral.
• Proficient computer skills including word processing, excel, and data entry.
• Must have ability to communicate professionally and effectively with management, co-workers, as well as vendors and other third parties.
• Precise documentation practices.
• Strong organizational skills.