Clinical Appeals Advocate
About The Position
As a Clinical Appeals Advocate, you will support patients who have been denied insurance coverage for Baxter’s Respiratory Health products. You will work with patients, healthcare teams, and insurance payers to appeal denials and help secure access to medically necessary therapies. The role requires clinical understanding, strong communication, and the ability to navigate payer policies. You will collaborate with Respiratory Health teams and build relationships with case managers and medical directors while supporting 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) 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 within a team.
- Proficiency in Microsoft Office and related software tools.
Nice To Haves
- A minimum of 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 appeal submissions for commercial and government payers.
- Communicate appeal strategies and patient responsibilities, and support patients in preparing 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.
- Discuss payer policies, coverage criteria, benefit limitations, potential costs, and product information with patients and healthcare teams to deliver a superior customer experience.
- Adhere to Hillrom and third-party payer policies while maintaining quality, compliance, and team contribution.
- Pursue ongoing learning, support workload coverage, and perform additional duties or projects as assigned.
Benefits
- Medical insurance
- Dental insurance
- Basic life insurance
- Accident insurance
- Short-term disability insurance
- Long-term disability insurance
- Business travel accident insurance
- Employee Stock Purchase Plan (ESPP), 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
- 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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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
