Insurance Verification Specialist

Baxter•Houston, TX

22h•Hybrid

About The Position

The Insurance Verification Specialist works to reintegrate patient accounts into the reimbursement process by obtaining prior authorizations, updating insurance information, or securing payment on claims. The role researches patient accounts in the error-processing workflow, identifies barriers to reimbursement, and provides summaries to support resolution. It verifies patient demographics and benefit information, processes claims, resolves delays, and applies payer-specific strategies to address reimbursement challenges. The specialist contacts patients, families, and caregivers to obtain current demographic, insurance, physician, and device-use information. The role also works with sales and internal and external Cardiology Healthcare teams, provides customer service regarding payer policies and coverage, and follows Baxter and third-party payer policies and compliance requirements. The position supports flexible workplace arrangements that require a minimum number of onsite days each week; the specific number is not stated.

Requirements

High school diploma or equivalent experience required.
2–3 years of healthcare-related revenue-cycle experience, with a focus on eligibility and benefit verification and claims submission.
Knowledge of Federal, State, and Local regulations, guidelines, and standards, including working knowledge of HIPAA rules and regulations.
Strong written, verbal, and interpersonal communication skills.
Excellent customer service skills and ability to deescalate conflict effectively and quickly.
Strong critical-thinking and problem-solving abilities.
Proficiency in Microsoft Office software.

Nice To Haves

Associate’s degree or higher preferred.
Cardiology-related experience is a plus.
Proven third-party payer experience is strongly preferred.
Experience reviewing medical records to identify and ensure medical necessity.

Responsibilities

Develop strategies to return patient accounts to the reimbursement process through prior authorization, insurance changes, or claim payment.
Research patient accounts in the error-processing process, identify reimbursement gaps, and provide comprehensive summaries for resolution.
Use investigative tools, including classified and confidential databases, to find patient contact information.
Ensure patient demographic and benefit information is accurate to minimize claim submission errors.
Process claims promptly and resolve issues that delay processing or adjudication.
Identify payer trends and implement payer-specific strategies to overcome reimbursement challenges.
Review revenue reports, including claim validation and return billing reports, to ensure reimbursement procedures are followed.
Contact patients, families, and caregivers to obtain current demographic, insurance, physician, and device-use information.
Follow up promptly and complete errors received and authorizations initiated.
Maintain favorable relationships with the sales team and internal and external Cardiology Healthcare teams.
Provide customer service and discuss payer policies, coverage criteria, and relevant plan or product information with patients and internal and external teams.
Seek additional experience and knowledge across functional areas.
Follow Baxter and third-party payer policies and maintain quality and compliance standards.

Benefits

Medical and dental coverage beginning on day one for eligible roles.
Basic life, accident, short-term disability, 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.
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.
Childcare benefits.