Clinical Appeals Advocate

Baxter; Deerfield (IL); Remote; USD 60,000 - 83,000; Full time

Benefits offered by this job

Health insurance

Dental coverage

401(k) with match

ESPP

Paid time off 20-35 days

Parental leave

Commuting benefits

Job summary

Baxter is seeking a Clinical Appeals Advocate to support patients denied insurance coverage for Respiratory Health products. You will work with patients, healthcare teams, and payers to overturn denials and secure access to medically necessary therapies, advancing our mission to Save and Sustain Lives.

This role requires clinical understanding, excellent communication, and the ability to navigate complex payer policies.

Qualifications

• RN/RT/LPN with active state licensure or certification.
• Associate degree or higher, or equivalent work experience in a clinical/reimbursement field.
• Minimum of 3 years reviewing medical records and securing third-party reimbursement.
• Knowledge of federal, state, and local regulations including HIPAA and payer guidelines.
• Exceptional written and verbal communication with strong attention to detail.
• Ability to multitask, prioritize, and work independently or in a team.
• Strong critical-thinking and problem-solving abilities; proficient with Microsoft Office.

Responsibilities

• Assess cases, develop appeal strategies, gather clinical documentation, and prepare submissions for payers.
• Communicate with patients to explain appeal strategies and support hearings when applicable.
• Create clinical case summaries and strengthen documentation for challenging payers.
• Process favorable decisions promptly and negotiate payments when denials are upheld.
• Build relationships with case managers and medical directors to promote positive outcomes.
• Discuss payer policies, coverage criteria, and product information to ensure a superior patient experience.
• Ensure adherence to Baxter and payer policies while maintaining high standards of quality and compliance.
• Seek learning opportunities and support workload coverage; perform additional duties as assigned.

Skills

RN/RT/LPN

Strong communication

Multitasking

Microsoft Office

Education

Associate degree

Tools

Microsoft Office

Job description

This is whereyour 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.

Your role at Baxter

As a Clinical Appeals Advocate, you will serve as a key patient advocate-supporting individuals who have been denied insurance coverage for Baxter's Respiratory Health products. You will work directly with patients, healthcare teams, and insurance payers to overturn denials, secure access to medically necessary therapies, and advance our Mission to Save and Sustain Lives.

This role requires strong clinical understanding, excellent communication skills, and the ability to navigate complex payer policies. You will collaborate crossfunctionally with Respiratory Health teams, build relationships with case managers and medical directors, and ensure a superior experience for patients throughout the appeals process.

This is a remote position based in the United States.

What you'll be doing

• Assess cases, develop appeal strategies, gather clinical documentation, and prepare persuasive appeal submissions for commercial and government payers.
• Communicate with patients to explain appeal strategies, outline their responsibilities, and support preparation for hearings when applicable.
• Create clinical case summaries and strengthen documentation for challenging payers or those with strict coverage criteria.
• Process favorable appeal decisions promptly, negotiate payment rates through letters of agreement, and determine appropriate resolutions when denials are upheld.
• Build and maintain professional relationships with case managers and medical directors to promote positive patient outcomes.
• Deliver a superior customer experience by discussing payer policies, coverage criteria, benefit limitations, potential costs, and product information with patients and healthcare teams.
• Ensure adherence to Hillrom and thirdparty payer policies while maintaining high standards of quality, compliance, and team contribution.
• Seek ongoing learning opportunities, support workload coverage, and perform additional duties or projects as assigned.

What you'll bring

• Registered Nurse (RN), Respiratory Therapist (RT), or Licensed Practical Nurse (LPN) required, with active state licensure or certification.
• Associate degree or higher, or equivalent work experience in a related clinical or reimbursement field.
• Minimum of 3 years of experience reviewing medical records and securing thirdparty reimbursement preferred.
• Knowledge of federal, state, and local regulations, including HIPAA requirements and payer guidelines.
• Exceptional written, verbal, and interpersonal communication skills with strong attention to detail.
• Ability to multitask effectively, prioritize critical responsibilities, and manage time independently.
• Strong criticalthinking and problemsolving abilities, with comfort working both independently and within a team.
• Proficiency in Microsoft Office and related software tools.

We understand compensation is an important factor as you consider the next step in your career. At Baxter, we are committed to equitable pay for all employees, and we strive to be more transparent with our pay practices. The estimated base salary for this position is $60,000to $82,500annually. The estimated range is meant to reflect an anticipated salary range for the position. We may pay more or less than of the anticipated range based upon market data and other factors, all of which are subject to change. Individual pay is based on upon location, skills and expertise, experience, and other relevant factors. For questions about this, our pay philosophy, and available benefits, please speak to the recruiter if you decide to apply and are selected for an interview.

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.

US Benefits at Baxter (except for Puerto Rico)

This is where your well-being matters. 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. Join us and enjoy the competitive compensation and benefits we offer to our employees.For additional information regarding Baxter US Benefits, please speak with your recruiter or visit our Benefits site: Benefits | Baxter

Equal Employment Opportunity

Baxter is an equal opportunity employer. Baxter evaluates qualified applicants without regard to race, color, religion, gender, national origin, age, sexual orientation, gender identity or expression, protected veteran status, disability/handicap status or any other legally protected characteristic.

Know Your Rights: Workplace Discrimination is Illegal

Reasonable Accommodations

Baxter is committed to working with and providing reasonable accommodations to individuals with disabilities globally. If, because of a medical condition or disability, you need a reasonable accommodation for any part of the application or interview process, please click on the link here and let us know the nature of your request along with your contact information.

Recruitment Fraud Notice

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