Biologics Coordinator

Job Summary:
The Biologics Coordinator is responsible for stewarding patients on buy and bill eligible drugs across multiple locations and practices, with the primary long-term objective of converting eligible patients to a buy and bill model as a revenue-generating service. This role serves as the strategic bridge between specialty pharmacy operations and in-office buy and bill administration, driving both patient continuity and financial growth.

This position provides leadership, coordination, and strategic direction across a regional patient population. It operates in close partnership with benefits and prior authorization (PA) teams, pharmacy partners, and clinical staff. The coordinator will report to the Biologics Manager and will support one or more Biologics Coordinators or Assistants.
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.
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 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
Physical Requirements:
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