Clinical Appeals Advocate

Baxter International-posted 3 months ago
$60,000 - $82,500/Yr
Saint Paul, MN
Computer and Electronic Product Manufacturing
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At Baxter, we believe every person—regardless of who they are or where they are from—deserves a chance to live a healthy life. It was our founding belief in 1931 and continues to be our guiding principle. We are redefining healthcare delivery to make a greater impact today, tomorrow, and beyond. Our Baxter colleagues are united by our Mission to Save and Sustain Lives. Together, our community is driven by a culture of courage, trust, and collaboration. Every individual is empowered to take ownership and make a meaningful impact. We strive for efficient and effective operations, and we hold each other accountable for delivering exceptional results. Here, you will find more than just a job—you will find purpose and pride.

  • Assess cases, develop appeal strategies, and set timelines to ensure appeal deadlines are met.
  • Contact patients to outline an appeal strategy and communicate their responsibilities in the appeal process.
  • Provide patients with assistance in preparation for appeal hearings as applicable.
  • Gather clinical documentation to support medical necessity for Respiratory Health products based on the selection criteria utilized by payers for coverage determinations.
  • Prepare and submit persuasive appeal/reconsideration requests to insurance companies including commercial and government payers such as Medicare and Medicaid.
  • Create clinical case summaries to strengthen submissions to challenge payers or payers with strict coverage criteria.
  • Process favorable appeal decisions from payers timely to streamline and drive revenue.
  • Negotiate payment rates for letter of agreement to ensure maximum collection potential.
  • Identify appropriate resolutions for accounts if denial is upheld by payer.
  • Initiate and develop professional working relationships with case managers and medical directors to promote positive outcomes for patients.
  • Provide superior customer experience by leveraging ability to discuss payer policies, coverage criteria, benefit limitations, potential cost, and any pertinent product information with patients and healthcare teams.
  • Understand and adhere to all policies for Baxter and 3rd party payers to ensure the highest standards of quality and compliance.
  • Consistently contribute to team goals and understand how they support greater organizational goals.
  • Actively seek additional experience and knowledge across all functional areas to gain expertise.
  • Provide workload coverage as needed.
  • Perform other duties and projects as assigned.
  • Licensed Practical Nurse (LPN), Registered Nurse (RN), or Respiratory Therapist (RT) required.
  • 2+ years of experience in reviewing medical records, obtaining third party reimbursement, appeals, prior authorization, claims or insurance.
  • Knowledge of federal, state, and local regulations, guidelines, and standards, including a working knowledge of HIPAA rules and regulations.
  • Exceptional written, verbal, and interpersonal communication skills.
  • Detail oriented and ability to multi-task.
  • Strong critical thinking and problem-solving skills.
  • Ability to work independently in a self-directed manner to complete tasks.
  • Possess ability to manage time and prioritize critical deadlines.
  • Proficiency in Microsoft Office Software, TIMS, Insurance Portal.
  • Medical and dental coverage that start on day one.
  • Insurance coverage for basic life, accident, short-term and long-term disability, and business travel accident insurance.
  • Employee Stock Purchase Plan (ESPP), with the ability to purchase company stock at a discount.
  • 401(k) Retirement Savings Plan (RSP), with options for employee contributions and company matching.
  • Flexible Spending Accounts.
  • Educational assistance programs.
  • Paid holidays.
  • Paid time off ranging from 20 to 35 days based on length of service.
  • Family and medical leaves of absence.
  • Paid parental leave.
  • Commuting benefits.
  • Employee Discount Program.
  • Employee Assistance Program (EAP).
  • Childcare benefits.
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