Clinical Appeals Advocate

Baxter•Saint Paul, MN

1d•Remote

About The Position

As a Clinical Appeals Advocate, you will serve as a key patient advocate—supporting individuals who have been denied insurance coverage for Baxter’s Respiratory Health products. You will work directly with patients, healthcare teams, and insurance payers to overturn denials, secure access to medically necessary therapies, and advance our Mission to Save and Sustain Lives. This role requires strong clinical understanding, excellent communication skills, and the ability to navigate complex payer policies. You will collaborate cross‑functionally with Respiratory Health teams, build relationships with case managers and medical directors, and ensure a superior experience for patients throughout the appeals process. This is a remote position based in the United States.

Requirements

Registered Nurse (RN), Respiratory Therapist (RT), or Licensed Practical Nurse (LPN) required, 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 effectively, prioritize critical responsibilities, and manage time independently.
Strong critical‑thinking and problem‑solving abilities, with comfort working both independently and within a team.
Proficiency in Microsoft Office and related software tools.
Applicants must be authorized to work for any employer in the U.S. We are unable to sponsor or take over sponsorship of an employment visa at this time.

Nice To Haves

Minimum of 3 years of experience reviewing medical records and securing third‑party reimbursement preferred.

Responsibilities

Assess cases, develop appeal strategies, gather clinical documentation, and prepare persuasive appeal submissions for commercial and government payers.
Communicate with patients to explain appeal strategies, outline their responsibilities, and support preparation for hearings when applicable.
Create clinical case summaries and strengthen documentation for challenging payers or those with 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.
Deliver a superior customer experience by discussing payer policies, coverage criteria, benefit limitations, potential costs, and product information with patients and healthcare teams.
Ensure adherence to Hillrom and third‑party payer policies while maintaining high standards of quality, compliance, and team contribution.
Seek ongoing learning opportunities, support workload coverage, and perform additional duties or projects as assigned.

Benefits

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