Biologics Coordinator

Key Responsibilities:

Buy and Bill Drug Oversight 

• Oversee enrollment and active management of patients on biologics drugs to ensure continuity of therapy and identification of conversion opportunities. 
• Monitor eligibility changes, formulary updates, and payer policy shifts for these drugs that may open new buy and bill conversion pathways. 
• Collaborate with the clinical team on therapeutic alternatives when these drugs face barriers to coverage. 

Prior Authorization & Benefits 

• Manage and monitor PA renewals for these patients, whether on specialty pharmacy or buy and bill, to ensure timely authorization and minimize gaps in therapy. 
• Lead benefits investigation for conversion candidates, including payer-specific buy and bill coverage analysis and appeal strategy. 
• Identify and escalate missed PA renewal cases and delegate corrective actions to team members. 

Revenue Cycle & Financial Oversight 

• Partner with RCM to monitor claims for buy and bill injections, ensuring accurate billing and expected reimbursement levels. 
• Review monthly reporting packages, including new buy and bill starts, active buy and bill patient counts, buy and bill conversion metrics, and reconciliation sign-off. 
• Identify revenue risk from leakage of these drugs to specialty pharmacy dispensing and develop action plans to address with clinic and pharmacy teams. 

Buy and Bill Stewardship & Conversion 

• Identify all active patients on buy and bill eligible drugs and manage proactively to maintain in-office administration. 
• Conduct systematic review of these patients at renewal to assess buy and bill conversion eligibility and initiate PA and benefits work accordingly. 
• Pursue buy and bill alternative pathways at the time of drug denial, working with benefits and PA teams to identify formulary substitutes. 
• Coordinate with pharmacy partners and patients to facilitate smooth transitions from specialty pharmacy dispensing to in-office buy and bill. 
• Maintain and report on a conversion pipeline, tracking patients by status (candidate, in-process, converted, ineligible). 
• Review and verify patient schedules to ensure appropriate drug ordering based on scheduled patient

IG Patient Management 

• Oversight and steward IVIG/SCIG patients, maintaining coordination with pharmacy and patient contacts. 
• Track patient concentration by location to inform long-term infusion clinic planning and resource allocation. 
• Serve as the primary liaison for IG-related coordination issues across clinics, pharmacy, and patient stakeholders. 

• Strong understanding of buy and bill reimbursement models and specialty pharmacy operations 
• Experience with prior authorization processes and benefits investigation, including payer-specific buy and bill coverage analysis 
• Understanding of Revenue Cycle Management and Biologics Billing 
• Excellent organizational and project management skills with the ability to manage a regional patient population 
• Strong communication skills, both verbal and written 
• Creative problem-solving and sound decision-making ability 
• Strategic and analytical mindset with keen attention to detail 
• Excellent relationship management skills; ability to work collaboratively with internal and external teams 
• Ability to lead, train, and motivate a team 
• Accountability, adaptability, and discretion 
• Ability to travel across assigned region 
• Clinical background (clinician preferred) 
• PACS certification or at least two years of prior authorization experience 
• Experience with specialty biologics, IVIG/SCIG, or infusion therapy management 
• Familiarity with Lux Infusion or similar specialty pharmacy coordination platforms 
• Ability to analyze data and reports to drive operational decisions 

• Ability to sit for extended periods and communicate effectively, including speaking and hearing
• Ability to perform repetitive tasks such as typing
• Information processing, memory recall and ability to exercise independent judgment

PACS certification or 2+ years prior authorization experience; experience with buy and bill reimbursement, specialty pharmacy, biologics/IVIG/SCIG; ability to travel; clinical background preferred.

Key Responsibilities

• managing biologics patients
• overseeing prior authorizations
• coordinating revenue cycle

Skills & Tools

Lux Infusion

Job Details

• Category: Healthcare Services - Allied Health
• Seniority: Mid Level
• Commitment: Full Time
• Workplace: Remote — United States or Virginia or District of Columbia or Maryland or Birmingham or Ohio or Dallas
• Languages: English

Benefits

• 401k matching
• Generous paid time off
• Retirement plan

About AllerVie Health

A healthcare company providing compassionate allergy care and biologics management. — Industry: Healthcare