Clinical Appeals Advocate: Nurse Champion for Patient Access

00026 ADVANCED RESPIRATORY, INC. USA; Saint Paul (MN); Vor Ort; USD 60.000 - 83.000; Vollzeit

Benefits dieser Stelle

Medical and dental coverage

Employee Stock Purchase Plan (ESPP)

401(k) Retirement Savings Plan

Flexible Spending Accounts

Paid time off 20 to 35 days

Zusammenfassung

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.

Qualifikationen

• 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.

Aufgaben

• 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.

Kenntnisse

Communication skills

Attention to detail

Multitasking

Microsoft Office

Ausbildung

Associate degree or higher

Active state licensure or certification

Tools

Microsoft Office

Jobbeschreibung

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.