Senior Biologics Coordinator

Senior Biologics Coordinator

SUMMARY

ESSENTIAL DUTIES AND RESPONSIBILITIES

Buy and Bill Drug Oversight

• Oversee enrollment and active management of patients on Xolair, Nucala, Fasenra, Tezspire, and Exdensur across assigned locations 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.
• Monitor inventory and drug ordering for assigned sites, including review of daily inventory completion and identification of excess drug inventory.

Specialty Pharmacy Oversight

• Oversee SP patient management across assigned locations, including new starts, referrals, transfers, and patients with open or pending SP fills.
• Monitor time to therapy for SP patients and work with pharmacy partners, clinics, and PA teams to resolve delays.
• Serve as the point of contact for specialty pharmacy partners on escalated dispensing, shipment, and patient access issues.
• Identify SP patients who may be candidates for conversion to buy and bill and route them into the conversion pipeline.

Prior Authorization & Benefits

• Manage and monitor PA renewals for buy and bill and SP patients 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.
• Review complex or escalated PA denials and appeals and guide Biologics Coordinators on the next steps.
• 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.
• Triage, resolve, or delegate follow-up on escalated claims and denials between Legacy and Practice teams.
• Support preparation and review of monthly reporting packages, including new starts (buy and bill and SP), active buy and bill patient counts, buy and bill conversion metrics, no starts / no shows with action plans, and end-of-month reconciliation.
• 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 across assigned locations, tracking patients by status (candidate, in-process, converted, ineligible).

Operations & Team Leadership

• Provide day-to-day direction, training, and support to Biologics Coordinators and Assistants across assigned locations.
• Review and verify patient schedules to ensure appropriate drug ordering based on scheduled patients and current inventory levels.
• Serve as the first level of escalation for Biologics Coordinators, resolving issues directly or escalating to the Biologics Manager as needed.
• Assist the Biologics Manager with weekly team meetings by preparing and presenting metrics such as new starts, SP conversions, orders, time to therapy, and billed injections.
• Conduct chart audits to ensure BE completion and accurate biologics documentation, notes, and reminders.
• Identify operational obstacles involving clinics, vendors, and biologics partners and drive resolution.
• Serve as a point of contact for providers, manufacturers, and third-party vendors.
• Support onboarding and cross-training of new team members and recognize and celebrate team successes.
• Travel to assigned locations as needed to support operations, providers, and staff.

IG Patient Management

• Oversight and steward IVIG/SCIG patients through the Lux Infusion platform, 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.

QUALIFICATIONS

• 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 multi-location 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 locations

SKILLS REQUIRED

• Clinical or RCM experience with medical prior authorizations (required)
• PACS certification or at least two years of prior authorization experience
• Minimum of two years of experience in a biologics coordinator role or equivalent, with experience in both buy and bill and specialty pharmacy workflows
• Experience with specialty biologics, IVIG/SCIG, or infusion therapy management
• Prior experience training or leading a team preferred
• Ability to analyze data and reports to drive operational decisions