Position Summary
The Home Infusion Pharmacy Intake Coordinator supports the referral-to-start-of-care process for patients receiving acute and specialty home infusion services. This position is responsible for processing new referrals, verifying insurance benefits, documenting payer requirements, estimating patient financial responsibility, obtaining required clinical and financial documentation, and coordinating communication among patients, healthcare providers, insurance plans, sales representatives, and internal departments.
The Intake Coordinator plays an important role in ensuring acute and specialty therapy referrals are processed accurately and efficiently while supporting timely access to care, excellent customer service, and compliance with applicable company, payer, accreditation, and regulatory requirements.
Essential Duties and Responsibilities
Receive and process new patient referrals for acute and specialty home infusion therapies through fax, email, electronic portals, telephone calls, and other approved communication methods.
Enter patient demographics, insurance information, prescriber information, diagnoses, medications, therapy type, and referral details into the pharmacy management system.
Review prescriptions, clinical records, laboratory results, insurance information, and other referral documents for completeness and accuracy.
Identify whether referrals are for acute or specialty infusion services and route them to the appropriate internal team or workflow.
Contact referral sources, sales representatives, patients, caregivers, hospitals, healthcare facilities, and other appropriate parties to obtain missing or corrected documentation.
Perform insurance eligibility and benefit verification for medications, administration supplies, equipment, nursing services, and other related home infusion services.
Document payer-specific information, including copayments, coinsurance, deductibles, out-of-pocket maximums, prior authorization requirements, step-therapy requirements, coverage limitations, network restrictions, and specialty pharmacy restrictions.
Calculate or assist with calculating estimated patient financial responsibility based on verified benefits, payer contracts, fee schedules, and company self-pay pricing.
Communicate benefit information and estimated financial responsibility to patients and caregivers clearly, professionally, and compassionately.
Review and interpret payer reimbursement information, including NDC-based and HCPCS unit-based reimbursement, when applicable.
Coordinate with the Authorization Department regarding prior authorization, medical necessity, step therapy, appeals, and payer documentation requirements.
Work with pharmacists, nurses, authorization specialists, reimbursement personnel, and other clinical staff to confirm therapy requirements, product selection, dosing information, delivery needs, nursing coordination, and required clinical documentation.
Generate and prepare new-patient start-of-care paperwork and verify that all required documents are complete before processing.
Support timely hospital discharge and transition-of-care referrals for acute home infusion patients.
Complete patient welcome calls and explain the pharmacy's intake, authorization, financial, delivery, nursing, and onboarding processes.
Communicate referral status, coverage updates, missing information, and next steps to patients, caregivers, referral sources, payer representatives, sales representatives, and internal departments.
Refer patients to or assist with enrollment in manufacturer copay assistance programs, patient assistance programs, charitable foundations, and other financial support resources when appropriate.
Maintain clear, complete, and timely documentation of all calls, benefit findings, outreach attempts, financial information, and referral updates.
Track acute and specialty referrals through each stage of the intake process and follow up on outstanding documents, approvals, discharge dates, and patient communication.
Escalate clinical, reimbursement, authorization, service, financial, or discharge-related concerns to the appropriate department or supervisor.
Support billing and collection efforts by maintaining accurate insurance, reimbursement, and patient financial information.
Meet established productivity, accuracy, quality, and turnaround-time expectations.
Protect patient confidentiality and comply with HIPAA, company policies, accreditation standards, payer requirements, and applicable pharmacy regulations.
Participate in departmental meetings, training programs, and process-improvement initiatives.
Perform other duties as assigned.
Required Qualifications
High school diploma or equivalent.
At least 18 years of age.
Strong interpersonal skills with the ability to interact professionally with patients, caregivers, employees, supervisors, healthcare providers, payer representatives, hospital personnel, sales representatives, and external partners.
Strong computer skills, including proficiency with email, telephone systems, Microsoft Office, pharmacy applications, and electronic documentation systems.
Strong organizational, time-management, and documentation skills.
Ability to manage multiple acute and specialty referrals and changing priorities while maintaining accuracy and timeliness.
Ability to communicate clearly and effectively through verbal and written communication.
Ability to maintain confidentiality and appropriately handle protected health information.
Preferred Qualifications
One or more years of experience in home infusion, specialty pharmacy, acute care, hospital discharge coordination, pharmacy intake, patient access, benefit verification, prior authorization, medical billing, reimbursement, or healthcare administration.
Experience processing acute and specialty home infusion referrals.
Specialty pharmacy or pharmacy benefit manager experience.
Knowledge of Commercial, Medicare, Medicaid, and managed care reimbursement requirements.
Understanding of billing and collection processes across multiple payer types.
Ability to interpret payer contract fee schedules and NDC- or HCPCS-based reimbursement.
Registered Pharmacy Technician with the applicable State Board of Pharmacy, preferred.
Medical Assistant or Pharmacy Technician education or experience.
Familiarity with medical terminology, diagnosis codes, medication orders, acute infusion therapies, specialty medications, and clinical documentation.
Knowledge, Skills, and Abilities
Excellent customer service and telephone communication skills.
Strong attention to detail and data-entry accuracy.
Ability to interpret insurance eligibility and benefit information.
Ability to understand and explain patient financial responsibility.
Ability to prioritize urgent acute referrals and manage specialty referrals with longer authorization or onboarding timelines.
Ability to prioritize multiple referrals and meet established deadlines.
Ability to work independently while contributing to a collaborative team environment.
Ability to communicate professionally with patients who may be experiencing medical or financial concerns.
Sound judgment and the ability to recognize when an issue should be escalated.
Dependability, professionalism, and consistent attendance.
Ability to adapt to changing procedures, payer requirements, technology, and operational priorities.
Physical Requirements
Ability to sit at a desk or workstation for prolonged periods, potentially up to eight hours per day, while using a computer and telephone system.
Frequent use of hands and fingers to operate a computer keyboard, mouse, telephone headset, and other standard office equipment.
Ability to communicate clearly by telephone, video conference, email, and in person.
Ability to hear and understand information during extended telephone interactions.
Ability to read and review information displayed electronically and in printed documents.
Ability to occasionally stand, walk, bend, reach, and lift or carry office materials weighing up to 20 pounds.
Reasonable accommodations may be provided to qualified individuals with disabilities.
Work Environment
This position may be performed onsite at the pharmacy or from an approved home-based workspace, depending on operational needs and the employee's assigned work arrangement.
Employees working from home must maintain a private, secure, professional, and distraction-free workspace that protects patient confidentiality and complies with HIPAA requirements. Reliable internet access and appropriate use of company-provided equipment, telephone systems, and electronic communication platforms are required.
Employees may be required to report to the pharmacy for training, meetings, equipment needs, or other operational purposes. When working onsite, employees must follow all pharmacy safety procedures and use personal protective equipment when required.
Schedule and Benefits
Full-time, Monday-Friday schedule.
Medical, dental, and vision insurance.
Paid time off.
Paid holidays.
Retirement plan with company match.
Employee-paid voluntary benefit options available through payroll deductions.
Training and professional development opportunities.
About Us
Capstone Health, LLC dba Capstone Vital Care and its affiliated franchise entities are proud franchises of Vital Care Infusion Services, Inc., a recognized leader in acute and specialty home infusion therapy.
As an established provider of acute and specialty home infusion services, Capstone Vital Care is committed to delivering high-quality, patient-centered care in the comfort of patients' homes. Our multidisciplinary team of pharmacists, nurses, intake coordinators, authorization specialists, reimbursement personnel, sales representatives, and support staff works collaboratively to improve patient outcomes through personalized medication management, clinical support, and coordinated transitions of care.
Mission Statement
Capstone Health, LLC dba Capstone Vital Care delivers efficient, expedient, and exemplary acute and specialty home infusion services to patients and referral sources throughout the communities we serve.
Vision Statement
Capstone Health, LLC dba Capstone Vital Care will be the preferred provider of acute and specialty home infusion therapies throughout the communities we serve. We recognize the value of our employees and maintain a commitment to providing superior service to patients who choose us as their trusted home infusion pharmacy.
Equal Employment Opportunity
Capstone Health, LLC dba Capstone Vital Care and its affiliated entities are Equal Opportunity Employers. Employment decisions are made without regard to any characteristic protected by applicable federal, state, or local law.
