Reimbursement Specialist

Baxter•Saint Paul, MN

2d•Hybrid

About The Position

The Reimbursement Specialist is responsible for reimbursement-related duties for an assigned territory or payer group. The role handles eligibility and benefit verification, collection and assessment of clinical documentation, prior authorization and reauthorization submissions, letter of agreement payment negotiations, and timely processing of payer decisions. The specialist communicates with patients, healthcare teams, and insurance companies and collaborates with other Respiratory Health teams to support patient outcomes and caregivers. The position requires adherence to Baxter and third-party payer policies, strong customer service, and contributions to team and organizational goals. Baxter’s flexible workplace policy requires a minimum of three days per week onsite.

Requirements

At least 3 years of industry experience.
Exceptional written, verbal, and interpersonal communication skills.
Strong critical-thinking and problem-solving skills.
Detail-oriented with the ability to multitask.
Ability to work independently and as part of a team.
Ability to manage time and prioritize critical priorities.
Proficiency in Microsoft Office software.

Nice To Haves

Industry experience in health insurance and/or durable medical equipment is preferred.
Third-party payer experience is strongly preferred.
Experience with Total Information Management System (TIMS) is beneficial.

Responsibilities

Verify eligibility and benefits to determine coverage and payer requirements.
Load benefit information accurately to reduce rework and support clean claims.
Gather clinical documentation supporting medical necessity for Respiratory Health products.
Assess documentation to ensure prescription, face-to-face, and coverage criteria requirements are met.
Prepare and submit prior authorization requests to commercial and government payers, including Medicare and Medicaid.
Process payer authorization decisions in a timely manner.
Negotiate payment rates for letters of agreement to maximize collection potential.
Communicate payer policies, coverage criteria, benefit limitations, potential costs, and relevant product information to patients and healthcare teams.
Adhere to Baxter and third-party payer policies and requirements for quality and compliance.
Contribute to team goals and understand how they support organizational goals.
Seek experience and knowledge across functional areas and perform other assigned duties and projects.

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.