Remote Infusion Clinical Review and Appeals Coordinator

Soleo Health Inc; Frisco (TX); Remote; USD 65,000 - 90,000; Full time

Benefits offered by this job

Competitive Wages

Flexible schedules

401(k) with a match

Referral Bonus

Paid Time Off

Annual Merit Based Increases

No Weekends or Holidays

Medical/Dental/Vision Insurance

Disability and Basic Life Insurance

HSA and FSA options

Education Assistant Program

Job summary

Soleo Health is seeking an Infusion Clinical Review Coordinator to support our Specialty Infusion Pharmacy and work remotely in the USA. The role involves researching and providing timely clinical reviews on complex patient cases to secure approvals and reduce denials.

Prior authorization and appeal activities are central to success. The ideal candidate will have specialty infusion pharmacy experience, strong communication skills, and familiarity with medical policy.

Qualifications

• Preferred qualifications include Medical Assistant, LPN, or RN.
• Experience with specialty infusion pharmacy is required.
• Bachelor’s degree or 3 years in a qualified position.

Responsibilities

• Evaluate patient clinicals and payer criteria to determine medical necessity.
• Review progress notes, labs, and plans to satisfy payer policy.
• Request missing clinical information to render decisions.
• Assist with clinical support packets for prior authorizations and appeals.
• Construct concise clinical cases to support denials and appeals.
• Develop and maintain a library of clinical resources for appeals.

Skills

Specialty infusion pharmacy experience

Denial support

Clinical reviews

Appeals

Communication skills

MS Office (Word/Excel/PP)

Education

Bachelor's degree in healthcare

Tools

Microsoft Word

Microsoft Excel

PowerPoint

Job description

Soleo Health is seeking an Infusion Clinical Review Coordinator to support our Specialty Infusion Pharmacy and work remotely in the USA. The role involves researching and providing timely clinical reviews on complex patient cases to secure approvals and reduce denials.

Prior authorization and appeal activities are central to success. The ideal candidate will have specialty infusion pharmacy experience, strong communication skills, and familiarity with medical policy.