Clinical Appeals Advocate

Baxter; United States; Remoto; USD 60.000 - 83.000; Tempo pieno

Vantaggi offerti da questo lavoro

Health insurance

Dental coverage

Disability insurance

Retirement benefits

Employee stock purchase plan

Descrizione del lavoro

Baxter is seeking a Clinical Appeals Advocate to support patients denied insurance coverage for Respiratory Health products. You will overturn denials, secure access to therapies, and collaborate with healthcare teams and payers to advance our mission.

This is a remote role based in the United States. You will assess cases, craft appeal strategies, gather clinical documentation, and communicate effectively with patients and case managers to promote favorable outcomes.

Competenze

• Active state licensure as RN/RT/LPN required.
• Associate degree or higher in clinical/reimbursement field or equivalent.
• Minimum 3 years of experience reviewing medical records and securing third‑party reimbursement.
• Knowledge of HIPAA and payer guidelines.
• Strong written and verbal communication and attention to detail.
• Ability to multitask, prioritize, and work independently.
• Proficiency in Microsoft Office and related software.

Mansioni

• 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.

Conoscenze

Clinical documentation

Communication skills

Multitasking

Time management

Critical thinking

Formazione

Nursing licensure

Associate degree or higher

Strumenti

Microsoft Office

Descrizione del lavoro

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.

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 cross‑functionally 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 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.

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 $60,000 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.

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