Biologics Coordinator

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:

Accurately review biologics charges from Waystar and database system in a timely manner

Ability to be very detailed in all tasks

Work closely with hub personnel and Biologics Team to ensure that all biologics billing is entered into database according to Allergy Partners guidelines

Efficiently obtain information from account reimbursement specialists, practice managers, and insurance companies to identify changes in billing guidelines, and communicate changes in centralized location

Report regularly on statistics of charges receipts and adjustments as well as exceptions and problem areas and maintain accurate record of changes and education of proper procedure

Become well versed on biologics billing as well as becoming familiar with different insurance payers limitations, exclusions, or other restrictions

Assist in education to the practices including registration for Allergy Partners rebate and discount programs

Provide general oversight of prior authorization process as well as re-certification

Ability to work successfully under pressure

Assist hubs as needed with flexibility and willingness and accurate information

Identify issues promptly, and communicate to proper personnel

Provide status quickly and accurately of tasks at hand such as outstanding claims to be reviewed before filing as well as statistics on improper process and procedure and training provided

Help ensure profit of biologics billing and report regularly to appropriate personnel by identifying at risk items in the process

Complete ad-hoc projects and other duties as requested

Demonstrates professionalism and promotes positive interpersonal relations with all internal and external business contacts, representing corporation in a positive manner, displaying personal commitment to achieving the goals and objectives of the corporation

Other

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

Maintains detailed knowledge of practice management and other computer software (i.e. Excel) as it relates to job functions.

Attends OSHA, HIPAA, and OIG training programs as required.

Attends all meetings as requested including regular staff meetings.

Attends Medicare and other continuing education courses as requested. Pursue and participate in education to remain current with changes in the Healthcare industry.

Performs any additional duties as requested by Manager / Supervisor.

Completes all assigned AP training (such as CPR, OSHA, HIPAA, Compliance, Information Security, others) within designated time frames.

Complies with Allergy Partners and respective hub/department policies and reports incidents of policy violations to a Supervisor/Manager/Director, Department of Compliance & Privacy or via the AP Ethics Point hotline.

Supervisory Responsibilities This job has no supervisory responsibilities.

Typical Physical Demands Physical demands are moderate with occasional lifting of…