Spec, Insurance Discovery

Baxter International Inc.•Houston, TX

8d•$44,800 - $61,600•Hybrid

About The Position

This position provides direct support to the Revenue Cycle Management Department, which includes Reimbursement Services, Cash Application, Patient Account Specialist, Billing and Collections. This position is required to collaborate cross-functionally with other Cardiology healthcare teams to coordinate and align in our mission statement of Saving and Sustaining Lives. The Spec, Insurance Discovery position requires use of data analysis tools and reporting, along with comprehensive understanding of the revenue cycle process, 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

High school diploma or equivalent required, associate’s degree or higher preferred.
2+ years of healthcare related experience in the revenue cycle process with a specialized focus around eligibility and benefit verification, claims submission. Cardiology related experience a plus.
Knowledge of insurance industry and third-party payer processes
Excellent data entry skills required
Ability to organize and prioritize workload
Strong attention to detail while balancing high volume data entry
Proficiency in Microsoft Office software
Knowledge of Federal, State, and Local regulations, guidelines, and standards, including a working knowledge of HIPAA rules and regulations.
Third-party payer experience strongly preferred.
Experience with medical record reviews to identify and ensure medical necessity preferred
Excellent customer service skills. The ability to deescalate conflict effectively and quickly as it arises, a plus.
Strong critical thinking and problem-solving skills.
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

Cardiology related experience a plus.
The ability to deescalate conflict effectively and quickly as it arises, a plus.

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 that fall into our “Error processing” process, to identify the gaps preventing reimbursement and provide a summary for resolution.
Utilize various investigational tools to locate patient contact info, including use of classified and confidential databases.
Ensure the accuracy of patient demographics and benefit information on file to reduce claim submission errors.
Ensure claims are processed promptly, while identifying and resolving claims issues resulting in delayed processing and adjudication.
Identify payer trends and establish payer-specific strategies to overcome reimbursement challenges.
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/Clients and Account Executives as needed to obtain current demographics, insurance, physician, and device usage, to ensure appropriate insurance reimbursement.
Ensure timely follow-up and follow-through of errors received and authorizations initiated.
Establish and maintain positive partnerships with sales team and other internal and external Cardiology Healthcare teams.
Provide effective and superior customer service by leveraging ability to discuss payer policies, coverage criterion, or any pertinent plan or product information with patients, sales team, and other internal and external Cardiology Healthcare teams.
Consistently meets productivity while understanding how they support greater organizational goals.
Actively seek additional experience and knowledge across all functional areas to gain expertise.
Provide workload coverage as needed.
Understand and adhere to all policies for Baxter and third-party payers to ensure the highest standards of quality and compliance.
Perform other duties and projects as assigned.

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