RxTriage Liaison (Infusion)

This role is onsite in Durham, NC for the first 6-8 weeks of training. Once the new hire is fully stabilized, they will be able to work hybrid 2-3 days a week onsite.

Job Purpose: 

The company is seeking a highly motivated, detail-oriented, and dependable Triage Liaison to support our rapidly growing healthcare provider administered (HCPA) medication operations. This role is responsible for receiving, assessing, and directing incoming prescriptions and HCPA referrals to the appropriate site of care – Hospital Outpatient Departments (HOPD), Ambulatory Infusion Centers (AIC), Home Infusion (HI), or external/contract pharmacies/agencies. This role also ensures patients are routed efficiently based on insurance requirements, patient preference, clinical needs, reimbursement feasibility, and operational capacity. The RxTriage Liaison acts as the first decision point in the referral workflow process and collaborates with pharmacy, nursing, intake, revenue cycle management, and clinical partners to ensure timely access to care.  The RxTriage Liaison will support a specific specialty clinic/s or be part of a centralized intake team serving multiple clinics and disease states/diagnosis requiring infusion therapy.

Key Responsibilities

Referral Intake & Routing

• Receive and review all incoming specialty and HCPA medication orders/referrals.
• Evaluate referral type, diagnosis, therapy, urgency, payer requirements, patient preference/home-care eligibility and clinicals documentation to determine the correct pathway (HOPD, AIC, HI, external entities).
• Verify patient demographics, prescriber information, therapy details, and completeness of required documentation
• Identify whether medication is billable under medical or pharmacy benefits and route accordingly.

Benefit & Eligibility Screening (Initial-Level Triage)

• Conduct preliminary benefits review to identify:
  • Coverage requirements (site-of-care mandates, white-bagging, brown-bagging, or specialty pharmacy restrictions).
  • Whether therapy is eligible for in-house care vs. must be dispensed externally.
  • Potential red flags requiring escalation (e.g., no coverage, non-formulary status, narrow network).
• Communicate initial payer findings to the appropriate downstream teams (Intake Coordinator, Financial Coordinator, Pharmacy team, Partner, etc.).

 Clinical & Operational Assessment

• Confirm whether required clinical documentation is present (labs, progress notes, treatment plans, diagnoses, etc.).
• Identify missing elements and request documentation from providers as needed for appropriate routing.
• Assess operational considerations including:
  • Product availability or procurement barriers
  • Nursing service availability (for home infusion)
  • Infusion center capacity
  • Ensure readiness before finalizing referral destination.

Cross-Team Communication & Coordination

• Serve as the central liaison between intake, pharmacy, clinical teams, ambulatory infusion centers, and home infusion services.
• Communicate routing decisions clearly and promptly to:
• Pharmacy teams (internal and external)
• Nursing coordinators
• Intake/pre cert teams
• Providers and clinic staff
• Ensure referrals move seamlessly into the correct workflow for benefits investigation, authorization, scheduling, and dispensing.

Documentation & Compliance

• Accurately record all triage actions, decision rationale, communications, and next steps in designated platforms (e.g., EMR, TRX, referral management systems).
• Maintain compliance with payer rules, infusion therapy standards, and site of care policies.
• Support audits or quality reviews by ensuring documentation is complete and consistent.

Patient Interaction

• As needed, contact patients to clarify insurance, care preferences, or logistical considerations impacting routing.
• Provide a high-touch, supportive experience when discussing site-of-care expectations or next steps.

Additional Responsibilities

• Collaborate with formulary or reimbursement specialists to identify preferred alternatives when necessary.
• Support process improvement efforts to streamline triage and referral routing.
• Assist with staff training on referral pathways, payer rules, and site of care policies.

Skills: Strong interpersonal communication skills, ability to work independently and demonstrate good judgement, strong verbal and written communication, highly proficient