Clinical Appeals Advocate

Baxter•Saint Paul, MN

2d•Remote

About The Position

As a Clinical Appeals Advocate at Baxter, you will support patients who have been denied insurance coverage for Baxter Respiratory Health products. You will work with patients, healthcare teams, and insurance payers to challenge denials and help secure access to medically necessary therapies. The role calls for clinical knowledge, strong communication skills, and the ability to navigate payer policies. You will collaborate with Respiratory Health teams and develop relationships with case managers and medical directors while supporting patients throughout the appeals process. This is a remote position based in the United States. Applicants must be authorized to work for any U.S. employer; visa sponsorship is not available. The estimated annual base salary is $60,000 to $82,500. Individual pay may vary based on location, skills, expertise, experience, and other relevant factors.

Requirements

Registered Nurse (RN), Respiratory Therapist (RT), or Licensed Practical Nurse (LPN) credential, with active state licensure or certification.
Associate degree or higher, or equivalent work experience in a related clinical or reimbursement field.
Knowledge of federal, state, and local regulations, including HIPAA requirements and payer guidelines.
Exceptional written, verbal, and interpersonal communication skills, with strong attention to detail.
Ability to multitask, prioritize critical responsibilities, and manage time independently.
Strong critical-thinking and problem-solving abilities, and comfort working independently and as part of a team.
Proficiency in Microsoft Office and related software tools.
Authorization to work for any employer in the United States; employment visa sponsorship is not available.

Nice To Haves

At least 3 years of experience reviewing medical records and securing third-party reimbursement is preferred.

Responsibilities

Assess cases, develop appeal strategies, gather clinical documentation, and prepare persuasive submissions to commercial and government payers.
Explain appeal strategies and patient responsibilities, and help patients prepare for hearings when applicable.
Create clinical case summaries and strengthen documentation for challenging payers or strict coverage criteria.
Process favorable appeal decisions promptly, negotiate payment rates through letters of agreement, and determine appropriate resolutions when denials are upheld.
Build and maintain professional relationships with case managers and medical directors to promote positive patient outcomes.
Discuss payer policies, coverage criteria, benefit limitations, potential costs, and product information with patients and healthcare teams to provide a superior customer experience.
Follow Hillrom and third-party payer policies while maintaining quality, compliance, and team contribution standards.
Pursue ongoing learning, support workload coverage, and perform additional duties or projects as assigned.

Benefits

Medical and dental coverage beginning on day one for eligible roles.
Basic life, accident, short-term and long-term disability, and business travel accident insurance.
Employee Stock Purchase Plan with the ability to purchase company stock at a discount.
401(k) Retirement Savings Plan with employee contributions and company matching.
Flexible Spending Accounts.
Educational assistance programs.
Paid holidays and 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.