Spec, Reimbursement

Baxter•Opelika, AL

10h•Hybrid

About The Position

This is a full-time hybrid position where the candidate would report to the St. Paul office three days a week, Monday through Friday. The hours of operation are 8:00am-4:30pm CST. In this role you will perform Reimbursement Specialist duties for assigned territory or payer(s) including eligibility and benefit verification, documentation collection, prior authorization and reauthorization submissions, letter of agreement payment negotiations, and processing payer decisions. As the Reimbursement Specialist you will communicate directly with patients, healthcare teams, and insurance companies as well as collaborating cross-functionally with teams to coordinate in our mission of enhancing outcomes for patients and their caregivers.

Requirements

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
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

Experience with Total Information Management System (TIMS) a benefit.

Responsibilities

Perform verification of eligibility and benefits to determine coverage and payer requirements.
Ensure all benefit information is loaded correctly to reduce rework and allow for clean claims.
Gather clinical documentation to support medical necessity for Cardiology products and assess clinical documentation to ensure all applicable prescription, face to face, and coverage criteria requirements are met.
Prepare and submit prior authorization requests to insurance companies including commercial payers as well as government payers including Medicare and Medicaid.
Process authorization decisions from payers timely to streamline and drive revenue.
Negotiate payment rates for letter of agreement to ensure maximum collection potential.
Provide a superior customer experience by leveraging ability to discuss payer policies, coverage criteria, benefit limitations, potential cost, or any pertinent product information with patients and healthcare teams.
Understand and adhere to all policies for Baxter and 3rd party payers to ensure the highest standards of quality and compliance.
Ensure compliance with Federal Medicare, State Medicaid, and Third-Party requirements for in-state brick and mortar regulations, including but not limited to: Staff and maintain required brick and mortar location during the posted business hours, including answering of phone calls to site.
Organize and update state licensure information and other appropriate documentation to ensure it is in available upon audit of site.
Manage external audits from CHAP, Medicare, Medicaid, and licensing agencies.
Enter orders, provide confirmation notices, and follow-up with Healthcare Teams to obtain valid order requirements, as needed.

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