Spec, Insurance Verification

Baxter International Inc.•Houston, TX

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. Who We are: At Baxter, we are deeply connected by our mission. No matter your role at Baxter, your work makes a positive impact on people around the world. You’ll feel a sense of purpose throughout the organization, as we know our work improves outcomes for millions of patients. Baxter’s products and therapies are found in almost every hospital worldwide, in clinics and in the home. For over 90 years, we have pioneered significant medical innovations that transform healthcare. Together, we create a place where we are happy, successful and inspire each other. This is where you can do your best work. Join us at the intersection of saving and sustaining lives—where your purpose accelerates our mission. What you'll be doing: Develop a flawless strategy to reintegrate patient accounts into the reimbursement process, either through acquiring prior authorization, performing change of insurance, or securing payment on claims. Perform detailed research on patient accounts within our “Error processing” process to identify gaps hindering reimbursement and offer a comprehensive summary for resolution. Apply outstanding investigational tools to find patient contact information, including classified and confidential databases. Ensure the accuracy of patient demographics and benefit information on file to minimize claim submission errors. Process claims promptly, identifying and resolving issues causing delayed processing and adjudication. Identify payer trends and implement payer-specific strategies to overcome reimbursement challenges. Review revenue reports like "claim validation" and "return billing report" to ensure reimbursement procedures are followed. Contact patients, families, and caregivers as needed to acquire current demographics, insurance, physician, and device usage information to ensure appropriate insurance reimbursement. Ensure timely follow-up and completion of errors received and authorizations initiated. Foster and uphold favorable relationships with the sales team and other internal and external Cardiology Healthcare teams. Offer outstanding customer service through discussions on payer policies, coverage criteria, or relevant plan and product information with patients, sales team, and other internal and external Cardiology Healthcare teams. Consistently meet efficiency goals while understanding their support for greater organizational objectives. Actively seek additional experience and knowledge across all functional areas to gain expertise. Provide workload coverage as needed. Understand and adhere strictly to all policies for Baxter and third-party payers, ensuring the highest standards of quality and compliance. Perform other duties and projects as assigned.

Requirements

High school diploma or equivalent experience required, associate’s degree or higher preferred.
2-3 years of healthcare-related experience in the revenue cycle process with a specialized focus on eligibility and benefit verification, and claims submission.
Knowledge of Federal, State, and Local regulations, guidelines, and standards, including a working knowledge of HIPAA rules and regulations.
Proven third-party payer experience is strongly preferred.
Experience with medical record reviews to identify and ensure medical necessity.
Outstanding written, verbal, and interpersonal communication skills.
Excellent customer service skills with the ability to deescalate conflict effectively and quickly.
Strong critical thinking and problem-solving abilities.
Diligent and capable of multitasking.
Ability to work independently and as part of a team.
Ability to manage time and prioritize critical tasks.
Proficiency in Microsoft Office Software.

Nice To Haves

Cardiology-related experience is a plus.

Responsibilities

Develop a flawless strategy to reintegrate patient accounts into the reimbursement process, either through acquiring prior authorization, performing change of insurance, or securing payment on claims.
Perform detailed research on patient accounts within our “Error processing” process to identify gaps hindering reimbursement and offer a comprehensive summary for resolution.
Apply outstanding investigational tools to find patient contact information, including classified and confidential databases.
Ensure the accuracy of patient demographics and benefit information on file to minimize claim submission errors.
Process claims promptly, identifying and resolving issues causing delayed processing and adjudication.
Identify payer trends and implement payer-specific strategies to overcome reimbursement challenges.
Review revenue reports like "claim validation" and "return billing report" to ensure reimbursement procedures are followed.
Contact patients, families, and caregivers as needed to acquire current demographics, insurance, physician, and device usage information to ensure appropriate insurance reimbursement.
Ensure timely follow-up and completion of errors received and authorizations initiated.
Foster and uphold favorable relationships with the sales team and other internal and external Cardiology Healthcare teams.
Offer outstanding customer service through discussions on payer policies, coverage criteria, or relevant plan and product information with patients, sales team, and other internal and external Cardiology Healthcare teams.
Consistently meet efficiency goals while understanding their support for greater organizational objectives.
Actively seek additional experience and knowledge across all functional areas to gain expertise.
Provide workload coverage as needed.
Understand and adhere strictly to all policies for Baxter and third-party payers, ensuring the highest standards of quality and compliance.
Perform other duties and projects as assigned.

Benefits

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.

Stand Out From the Crowd

Upload your resume and get instant feedback on how well it matches this job.

Upload and Match Resume