Soleo Health

Team Lead

• Provide daily support and guidance to the Patient Access team
• Assist with escalations
• Participate in complex therapy benefit verification and prior authorization submissions
• Perform duties of both the Clearance Specialist and Prior Authorization Coordinator
• Oversee the clearance team’s workload and direct the work of other staff members
• Work autonomously to handle more complex issues related to benefits and authorization within established procedures and practices
• Provide exceptional customer service to external and internal customers, resolving any customer requests in a timely and accurate manner
• Ensure new team members understand their roles and responsibilities and provide ongoing training to enhance their skills and knowledge
• Provide necessary guidance, feedback and counseling and may contribute input for performance evaluations
• Create, update and distribute patient access-related reports as needed

Clearance Team Lead

Intake Coordinator

• The Clearance Specialist is responsible for processing new referrals including but not limited to verifying patient eligibility, test claim adjudication, coordination of benefits, and identifying patient estimated out of pocket costs.
• Perform benefit verification of all patient insurance plans including documenting coverage of medications, administration supplies, and related infusion services
• Responsible to document all information related to coinsurance, copay, deductibles, authorization requirements, etc
• Calculate estimated patient financial responsibility based off benefit verification and payer contracts and/or company self-pay pricing
• Initiate, follow-up, and secure prior authorization, pre-determination, or medical review including Reviewing and obtaining clinical documents for submission purposes
• Communicate with patients, referral sources, other departments, and any other external and internal customers regarding status of referral, coverage and/or other updates as needed
• Refer or assist with enrollment any patients who express financial necessity to manufacturer copay assistance programs and/or foundations
• Generate new patient start of care paperwork

Acute Clearance Specialist – Intake Coordinator

• The Clearance Specialist is responsible for processing new referrals including but not limited to verifying patient eligibility, test claim adjudication, coordination of benefits, and identifying patient estimated out of pocket costs.
• Perform benefit verification of all patient insurance plans including documenting coverage of medications, administration supplies, and related infusion services.
• Responsible to document all information related to coinsurance, copay, deductibles, authorization requirements, etc.
• Calculate estimated patient financial responsibility based off benefit verification and payer contracts and/or company self-pay pricing.
• Initiate, follow-up, and secure prior authorization, pre-determination, or medical review including reviewing and obtaining clinical documents for submission purposes.
• Communicate with patients, referral sources, other departments, and any other external and internal customers regarding status of referral, coverage and/or other updates as needed.
• Refer or assist with enrollment any patients who express financial necessity to manufacturer copay assistance programs and/or foundations.
• Generate new patient start of care paperwork.

Clearance Specialist – Intake Coordinator – Infusion

Manager

• Support the intake and reimbursement teams in the area of commercial contracting and government programs.
• Research payor contracts and other published information.
• Publication and maintenance of resource documents.
• Communication with provider relation teams to resolve contract and/or regulation non-compliance.
• Review payor contracts for intake and reimbursement contract terms.
• Work with Managed Markets team to address any missing or unfavorable intake and reimbursement contract terms.
• Provide comprehensive analyses of missing or unfavorable intake and reimbursement contract terms to VP of Reimbursement and CFO.
• Provide payor education to intake and reimbursement teams, including reimbursement trends and policies.
• Create, maintain, and manage all Intake and Reimbursement contract resource documents.
• Cultivate and maintain effective working relationships with contracted and non-contracted insurance Provider Relations personnel.
• Identify opportunities for cost savings and cash collections through payer reimbursement analysis/trends.

Reimbursement Contract Manager – Infusion

Business Development Rep

• Proactively identify, target, and establish partnerships with pharmaceutical manufacturers, specifically for specialty, rare, orphan, and blockbuster therapies with limited or exclusive distribution
• Position the Company as a premier specialty pharmacy partner by articulating the value Company brings to the patient journey including clinical capabilities, patient outcomes expertise, and market reach
• Develop and implement a roadmap for winning new drug access agreements and expanding the Company’s specialty portfolio
• Monitor emerging therapeutics, pipeline developments, and competitive market dynamics in the specialty and rare drug sectors
• Translate market intelligence into actionable strategies that inform business development priorities and executive decision-making
• Represent the Company at industry conferences, advisory boards, and pharma meetings to build visibility and credibility
• Build and sustain C-suite and senior-level relationships with pharmaceutical executives, consultants, and distribution partners
• Communicate the Company’s differentiated capabilities in patient services, payor relations, enhanced data and services, and clinical outcomes to secure manufacturer confidence
• Facilitate high-impact engagements between external partners and internal stakeholders (clinical, commercial, and operational teams)
• Lead and coordinate manufacturer Requests for Proposal (RFPs), including strategy, response development, and content differentiation
• Negotiate contract terms with pharmaceutical manufacturers to ensure favorable access, margin, and growth potential
• Collaborate with internal Pharma Relations and PMO teams to ensure flawless implementation, launch, and execution of new drug programs
• Partner with sales, clinical operations, payor relations, and marketing to support seamless implementation of newly secured products
• Audit assigned programs for profitability, performance, and compliance to ensure sustainability and continuous improvement
• Work within approved budgets and growth targets, driving measurable outcomes that align with the Company’s strategic plan
• Foster a collaborative and inclusive work environment, promoting effective communication and teamwork.

Vice President, Business Development – Pharma Relations

Data Engineer

• Support the development of scalable data pipelines, analytics solutions, and reporting tools.
• Develop and maintain analytics-ready datasets, transformations, and data models within Databricks and Azure-based data platforms.
• Build and support data transformation workflows, notebooks, and analytics processes utilizing Databricks within the Azure cloud environment.
• Support development and optimization of Power BI and Tableau dashboards, datasets, and reporting solutions.
• Collaborate with senior engineers to support Azure-based analytics architecture, data pipelines, integrations, and reporting environments.
• Support pipelines and transformation logic to prepare high quality, analytics ready datasets.
• Provide training, support, and best practice guidance to promote the adoption of self-service analytics tools across the organization.

Junior Data Engineer

Analyst

• Reviews all supporting documentation (delivery tickets, compound records, orders, invoices, payments etc.) for payor audits and refund requests
• Prepares, records and tracks all external audit findings and refund requests
• Provides audit results and communicates any risk associated with audit findings
• Researches, reconciles, and manages the unapplied cash account
• Recommends unapplied cash funds to take to revenue based on defined company criteria
• Completes necessary documents for payor EFTs
• Conducts monthly and quarterly cash/unapplied cash reviews and provides reports, as required by management

Cash Applications Analyst

Director

• Formulate and oversee the implementation of comprehensive regional and national Payor contracting and network management strategies
• Drive the achievement of contracted sales goals and enhance market share and profitability
• Lead the identification, development, negotiation, and management of Payor Relations agreements to ensure competitive and sustainable growth
• Initiate and guide the launch of innovative Payor relations programs and contracts, collaborating with senior internal stakeholders including operations, finance, and Regional Vice Presidents
• Oversee detailed financial analyses of Payor contracts to assess the earnings impact of new contracts, as well as renewals and material network changes
• Manage budget projections for pricing and assess financial performance of payor contracts
• Ensure Payors are reimbursing Soleo at the contracted rates and that reimbursement is timely
• Enhance Soleo’s contracting strategy to maximize value (where applicable) using national contracts with chain codes vs. individually contracted pharmacies
• Serve as the primary executive contact for major external partners, including hospitals, Payor organizations, and manufacturers
• Build and maintain strategic relationships to bolster business objectives
• Oversee the design and implementation of advanced sales training programs that focus on Payor relations, contract comprehension, opportunities, and associated risks
• Monitor and analyze market trends and contractual activities to identify and seize opportunities for new or expanded Payor agreements
• Lead the development of performance-based contracting models that reflect the latest in healthcare industry advancements and match organizational goals (i.e., Soleo’s participation in limited payor networks)
• Maintain and update the company's strategy in response to healthcare legislation changes
• Act as a subject matter expert to guide Payor Relations policies and practices
• Manage the creation and ongoing updates of departmental policies to ensure compliance with regulatory, operational, and organizational standards
• Partner with Revenue Cycle Management team to defend Soleo’s interests in payor audits
• Manage the creation and ongoing updates of departmental policies to ensure compliance with regulatory, operational, and organizational standards
• Completes all necessary managerial tasks for direct reports including hiring, training, addressing performance issues, developing team goals and objectives, performance reviews, conflict resolution, and strategic planning

Clearance Team Lead

Acute Clearance Specialist – Intake Coordinator

Clearance Specialist – Intake Coordinator – Infusion

Reimbursement Contract Manager – Infusion

Acute Clearance Specialist – Intake Coordinator

Vice President, Business Development – Pharma Relations

Junior Data Engineer

Cash Applications Analyst

Senior Director, Payor Relations