JOB OVERVIEW

The Implementation Manager for MedicoCX Biologics Optimization Support Service (BOSS) serves as a Biologic Coordinator, overseeing end-to-end biologic program operations within a medical specialty practice. This role is responsible for managing the collection of fee schedules, conducting benefit investigations, securing prior authorizations, enrolling patients in copay assistance programs, and providing financial navigation to patients. The Implementation Manager acts as a key liaison between patients, providers, payers, and pharmaceutical representatives to ensure timely and accurate access to biologic therapies. Strong organizational, communication, and problem-solving skills are essential for success in this role.

EXPERIENCE:

• Prior experience in biologic or specialty drug coordination, infusion therapy, or oncology. Familiarity with EMRs, claims management systems, payer portals, and manufacturer support programs.
• Strong knowledge of biologic therapies, treatment protocols, payer policies, and reimbursement models.
• Expertise in verifying insurance benefits and securing timely prior authorizations.
• Ability to navigate complex insurance systems and address coverage denials efficiently.
• Skilled in enrolling patients in financial assistance programs and communicating cost-saving options.
• Proficient in tracking and managing the claims process from submission through resolution.
• Capable of managing multiple workflows and meeting deadlines with high accuracy and attention to detail.
• Excellent verbal and written communication for interfacing with patients, providers, and insurance representatives.
• Strong customer service skills and a patient-focused approach.
• Able to troubleshoot complex issues related to insurance, authorizations, and claims.
• Collaborative approach when working with multidisciplinary teams and external partners.
• Ability to work independently while supporting larger team goals.
• Open to ongoing learning in biologics, healthcare systems, and technology updates.
  Certifications: PACS (Prior Authorization Certified Specialist) preferred but not required.

• Collect and review fee schedules and distributor costs for biologic medications and services on a quarterly basis.
• Conduct benefit investigations, verifying insurance coverage and identifying prior authorization requirements.
• Manage the complete prior authorization process, including submission, follow-ups, and resolution of denials.
• Enroll patients in copay assistance and patient support programs; provide tailored financial guidance.
• Coordinate the ordering, delivery, and inventory of biologic medications across assigned practices.
• Oversee the full claims reimbursement cycle to ensure accurate and timely payment for Buy and Bill patients.
• Serve as the primary point of contact for all biologic program stakeholders, including patients, providers, and payers.
• Collaborate with practice staff to obtain required clinical documentation and support program workflows.
• Maintain organized records, manage multiple tracking spreadsheets, and complete related EMR documentation.
• Provide continuous support and navigation to patients throughout their treatment journey.
• Assist with the creation and standardization of internal resources and therapy-specific guides (e.g., IVIG, neurotoxins).
• Support billing functions as needed, including managing claim submissions, tracking reimbursements, and troubleshooting denials.
• Represent MedicoCX at industry conferences and events as needed.