Spec, File Resolution

Baxter International Inc.•Saint Paul, MN

3d•$60,000 - $82,500•Hybrid

About The Position

This is where your work makes a difference. 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. Your role at Baxter The File Resolution Specialist is responsible for providing direct support to the Revenue Cycle Management Department, which includes Reimbursement Services, Medicare, Billing and Collections Teams. This position requires use of data analysis tools and reporting, along with comprehensive understanding of the revenue cycle, to analyze and resolve patient files that did not follow the standard reimbursement process. Additionally, this position will work with the management team to identify process and procedure gaps, to ensure maximum reimbursement potential.

Requirements

Associates degree or higher preferred
3+ years of industry experience, preferably in health insurance and/or durable medical equipment
Third party payer experience strongly preferred
Exceptional written, verbal, and interpersonal communications
Strong critical thinking and problem-solving skills
Detail orientated and ability to multi-task
Ability to work independently as well as in a team environment
Possess the ability to manage time and prioritize critical priorities
Proficiency in Microsoft Office Software
Experience with Total Information Management System (TIMS) a benefit

Responsibilities

Develop a plan and/or strategy to get patient accounts back into the reimbursement process flow, either through obtaining prior authorization, performing change of insurance, and/or obtaining payment on claims.
Complete complex research on patient accounts from intake, through billing and collections, to identify the gaps preventing reimbursement, and provide a summary for resolution.
Utilize various investigational tools such as Lexus Nexus, or Google to locate patient contact info, including use of classified and confidential database.
Identify trends and opportunities for improvement in various processes, to increase profitability and cash flow, along with recommended solutions to the RCM Management Team.
Identify files that need reactivation when escalated payer issues are resolved, and triage files to the appropriate departments, and provide direction regarding actions to take for reimbursement.
Maintain a standard review and audit process for all files entering a suspended/inactive status to ensure appropriate steps have been taken before exhausting reimbursement efforts.
Analyze and work various revenue reports, including, but not limited to “claim validation”, “return billing report”, to ensure all reimbursement procedures were followed, and claims can be released to payers or funneled back into the reimbursement process or accounts are closed out in the appropriate manner.
Contact patients/families/caregivers as needed to obtain current demographics, insurance, physician, and device usage, to ensure appropriate insurance reimbursement.
Obtain appropriate documentation such as medical records, Medicare Advanced Beneficiary Notice (ABN), Terms Conditions Responsibility Form (TCR), and Patient Waiver Form as needed for reimbursement.
Participate in various continuous improvement projects as assigned.

Benefits

Baxter is committed to supporting the needs for flexibility in the workplace. We do so through our flexible workplace policy which includes a minimum of 3 days a week onsite. This policy provides the benefits of connecting and collaborating in-person in support of our Mission.
US Benefits at Baxter (except for Puerto Rico) This is where your well-being matters. Baxter offers comprehensive compensation and benefits packages for eligible roles. Our health and well-being benefits include medical and dental coverage that start on day one, as well as insurance coverage for basic life, accident, short-term and long-term disability, and business travel accident insurance. Financial and retirement benefits include the Employee Stock Purchase Plan (ESPP), with the ability to purchase company stock at a discount, and the 401(k) Retirement Savings Plan (RSP), with options for employee contributions and company matching. We also offer Flexible Spending Accounts, educational assistance programs, and time-off benefits such as paid holidays, paid time off ranging from 20 to 35 days based on length of service, family and medical leaves of absence, and paid parental leave. Additional benefits include commuting benefits, the Employee Discount Program, the Employee Assistance Program (EAP), and childcare benefits.
For additional information regarding Baxter US Benefits, please speak with your recruiter or visit our Benefits site: Benefits | Baxter

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