This is a clinical-heavy, denial-prevention role built for someone who can read a complex chart, match it to payer criteria, and write appeals that actually win. If you’ve done infusion denial support and you’re strong with medical necessity language, this is a high-impact remote seat.
About Soleo Health
Soleo Health is a national provider of specialty pharmacy and infusion services delivered in the home or alternate sites of care. Their focus is simplifying complex care and improving patient outcomes, supported by a culture grounded in accountability, creativity, and doing the right thing.
Schedule
- Full-time, remote
- Monday–Friday, 8:30am–5:00pm Eastern Time
- No weekends or holidays
What You’ll Do
- Complete prior authorization clinical reviews by evaluating patient clinicals against payer medical necessity criteria
- Review progress notes, labs, infusion summaries, imaging, and plans of care to identify documentation that meets payer policy
- Request additional clinical information when needed to support decisions and next steps
- Build clinical support packets for initial authorizations and appeals
- For denials, write and document a clear, fact-based clinical case for appeal using nationally recognized medical necessity criteria
- Create and maintain an internal library of appeal templates, clinical resources, journal articles, and reference tools
- Stay current on payer medical policies, formularies, and coverage requirements and know how to locate payer resources quickly
- Assist with post-service denials and appeals
- Support outcome programs (data entry, reporting, and occasional patient calls as needed for denial support tasks)
- Provide training across departments on top disease states, specialty drugs, and best practices for prior auth and appeals
What You Need
- Bachelor’s degree in a healthcare field OR 3 years in a qualified position
- Experience with denial support, clinical reviews, and appeals for infusions (required)
- Preferred experience with specialty infusion patient needs and challenges
- Strong written, verbal, and presentation communication skills
- Strong customer service and interpersonal skills with a flexible communication style
- Ability to manage stress, prioritize, and meet program objectives
- Self-starter who is accountable and results-oriented
- Proficiency with Word, Excel, and PowerPoint
- Ability to communicate effectively across all levels of the organization
Benefits
- Pay: $68,000–$85,000/year
- Competitive wages
- Flexible schedules
- 401(k) with match
- Referral bonus
- Paid time off
- Annual merit-based increases
- Medical, dental, and vision insurance plans
- Company-paid disability and basic life insurance
- HSA & FSA options (including dependent care)
- Education assistance program
If your skill is turning “denied” into “approved,” this is your kind of role.
Build the case. Beat the denial. Get care started.
Happy Hunting,
~Two Chicks…