Biologics Coordinator

Job Details

Job Location
13-00-Winston Salem - Winston Salem, NC

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:

• 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 timeframes.
• 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 EthicsPoint hotline.

Supervisory Responsibilities

This job has no supervisory responsibilities.

Typical Physical Demands

Physical demands are moderate with occasional lifting of items weighing approximately 20-30 pounds. 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 must have normal range of hearing and vision must be correctable to normal range to record, prepare, and communicate appropriate reports.

Typical Working Conditions

Normal office environment. Occasional evening or weekend work.

Qualifications

EDUCATIONAL REQUIREMENTS:

• High school diploma. 3 years healthcare or related experience preferred.

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, and data entry
• Must have ability to communicate professionally and effectively with management, co-workers, hub personnel, as well as vendors and other third parties
• Detail oriented with the ability to accurately identify payer restrictions while reviewing biologics charges prior to insurance submission as well as updating Practice Management System with any changes
• Precise instructions to hubs related to incorrect biologics billing processes
• Ability to work independently and stay focused on the task at hand
• Strong organizational skills