Remote

BrightSpring Health Services•Englewood, CO

3d•$24 - $28•Remote

About The Position

The Specialty Admission Coordinator is responsible for managing specialty medication referrals from receipt through insurance clearance to ensure timely and accurate patient access to therapy. This role serves as the key point of contact for benefit investigation, prior authorization, coordination with internal stakeholders (pharmacy and nursing staff) and financial counseling with patients. The coordinator plays a critical role in ensuring referrals meet payer requirements and in facilitating seamless communication between patients, providers, pharmacy staff and the sales team.

Requirements

High school diploma or GED required; Associate’s or Bachelor’s degree preferred.
Minimum of 2 years of experience in a healthcare, specialty pharmacy, or insurance verification role.
Experience working with specialty medications, including benefit verification and prior authorization processes.
Experience in patient-facing roles is a plus, especially involving financial or benefit discussion.
Familiarity with payer portals.
Strong understanding of commercial, Medicare, and Medicaid insurance plans.
Proven track record of communicating effectively with internal and external stakeholders.

Nice To Haves

Experience in Microsoft BI.
Experience in Outlook, Word, and PowerPoint.

Responsibilities

Owns and manages the specialty referral from initial intake through insurance approval
Conducts timely and accurate benefit investigation, verifying both medical and pharmacy benefits
Identifies and confirms coverage criteria, co-pays, deductibles and prior authorization requirements
Prepares and submits prior authorization requests to appropriate payers
Maintains clear, timely communication with pharmacy teams, sales representatives and prescribers regarding the status of each referral and any outstanding information
Coordinates and delivers financial counseling to patients, including explanation of out-of-pocket costs, financial assistance options and next steps
Ensures all documentation complies with payer and regulatory requirements
Updates referral records in real-time within computer system
Collaborates with patient services and RCM teams to support a smooth transition to fulfillment
Tracks and reports referral statuses, turnaround times and resolution outcomes to support process improvement