Clinical Appeals Advocate

00026 ADVANCED RESPIRATORY, INC. USA; Saint Paul (MN); On-site; USD 60,000 - 83,000; Full time

Benefits offered by this job

Medical and dental coverage

Employee Stock Purchase Plan (ESPP)

401(k) Retirement Savings Plan

Flexible Spending Accounts

Paid time off 20 to 35 days

Job summary

Baxter is seeking a Clinical Appeals Advocate to support patients denied insurance coverage for Respiratory Health products. You will overturn denials by coordinating with patients, healthcare teams, and payers to secure access to medically necessary therapies.

Responsibilities include developing appeal strategies, preparing submissions, and negotiating resolutions while upholding HIPAA and payer guidelines. The role emphasizes collaboration and high-quality service.

Qualifications

• 3 years of experience reviewing medical records and securing third‑party reimbursement.
• Knowledge of federal, state and local regulations including HIPAA and payer guidelines.
• Active state licensure or certification is required.

Responsibilities

• Assess cases and develop appeal strategies with clinical documentation.
• Communicate with patients to explain appeal strategies and hearings when applicable.
• Create clinical case summaries and strengthen documentation for payers.
• Process favorable appeal decisions and negotiate payments when denials are upheld.
• Build relationships with case managers and medical directors to promote positive outcomes.
• Explain payer policies, coverage criteria, and product information to patients and teams.
• Ensure adherence to Baxter and payer policies while maintaining quality and compliance.
• Seek ongoing learning opportunities and support workload coverage.

Skills

Communication skills

Attention to detail

Multitasking

Microsoft Office

Education

Associate degree or higher

Active state licensure or certification

Tools

Microsoft Office

Job description

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.

Role and Responsibilities

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.

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 third‑party 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 third‑party 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 critical‑thinking and problem‑solving abilities, with comfort working both independently and within a team.
• Proficiency in Microsoft Office and related software tools.

Compensation

The estimated base salary for this position is $60,000 to $82,500 annually. 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.

Benefits

• 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.
• 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, 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.
• Commuting benefits, the Employee Discount Program, the Employee Assistance Program (EAP), and childcare benefits.

Employment Eligibility

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.

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.

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.

Closing

No matter your role at Baxter, your talent, skills, and time has a direct impact on people's lives. Since 1931, we have been at the forefront of innovation by bringing smarter, more personalized care to patients around the world. Now, we're more determined than ever to make a lasting impact as we are redefining healthcare delivery across the care journey. Our Mission to Save and Sustain Lives motivates us as we create a culture in which each of us can succeed. This is where you belong.