Reimbursement Specialist

Zvh; Saint Paul (MN); On-site; USD 42,000 - 57,000; Full time

Benefits offered by this job

Medical and dental coverage starting/1

ESPP and 401(k) matching

Paid holidays

Paid time off 20–35 days

Commuting benefits

Employee Discount Program

Employee Assistance Program (EAP)

Childcare benefits

Job summary

Baxter is seeking a qualified candidate to join our Healthcare Payer Operations team in Minnesota. The role focuses on verification of eligibility and benefits, documentation gathering for medical necessity, and submitting prior authorization requests to both commercial and government payers.

The ideal candidate brings 3+ years in health insurance, strong communication skills, and the ability to work both independently and in a collaborative setting.

Qualifications

• 3+ years of industry experience, preferably in health insurance or durable medical equipment.
• Strong written, verbal, and interpersonal communications.
• Ability to work independently as well as in a team environment.

Responsibilities

• Verify eligibility and benefits to determine coverage and payer requirements.
• Ensure benefit information is loaded correctly to reduce rework and enable clean claims.
• Gather clinical docs to support medical necessity for Respiratory Health products.
• Submit prior authorization requests for commercial and government payers (Medicare/Medicaid).
• Process authorization decisions timely to streamline revenue.
• Negotiate payment rates for letters of agreement to maximize collection.
• Provide excellent customer experience discussing payer policies and product information with patients and healthcare teams.

Skills

Health insurance experience

Payer communications

Critical thinking

Detail oriented

Tools

TIMS

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. Your role at Baxter THIS IS WHERE you build trust to achieve results…

What you’ll be doing

• Perform verification of eligibility and benefits to determine coverage and payer requirements.
• Ensure all benefit information is loaded correctly to reduce rework and allow for clean claims.
• Gather clinical documentation to support medical necessity for Respiratory Health products.
• Assess clinical documentation to ensure all applicable prescription, face to face, and coverage criteria requirements are met.
• Prepare and submit prior authorization requests to insurance companies including commercial payers as well as government payers including Medicare and Medicaid.
• Process authorization decisions from payers timely to streamline and drive revenue.
• Negotiate payment rates for letter of agreement to ensure maximum collection potential.
• Provide a superior customer experience by leveraging ability to discuss payer policies, coverage criteria, benefit limitations, potential cost, or any pertinent product information with patients and healthcare teams.
• Understand and adhere to all policies for Baxter and 3rd party payers to ensure the highest standards of quality and compliance.
• Consistently contribute to team goals and understand how they support greater organizational goals.
• Actively seek additional experience and knowledge across all functional areas to gain expertise and perform other duties and projects as assigned.

What you’ll bring

• 3+ years of industry experience, preferably in health insurance and/or durable medical equipment
• Third party payer experience strongly preferred.
• Exceptional written, verbal, and interpersonal communications
• Strong critical thinking and problem-solving skills
• Detail orientated and ability to multi-task.
• Ability to work independently as well as in a team environment.
• Possess the ability to manage time and prioritize critical priorities.
• Proficiency in Microsoft Office Software
• Experience with Total Information Management System (TIMS) a benefit.

The estimated base salary for this position is $41,600 to $57,200 annually. The estimated range is meant to reflect an anticipated salary range for the position. We may pay more or less than the anticipated range based upon market data and other factors, all of which are subject to change. Individual pay is based upon location, skills and expertise, experience, and other relevant factors.

Baxter is committed to supporting the needs for flexibility in the workplace. We do so through our flexible workplace policy which includes a minimum of 3 days a week onsite. This policy provides the benefits of connecting and collaborating in-person in support of our Mission.

US Benefits at Baxter (except for Puerto Rico)

• 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, and the 401(k) Retirement Savings Plan (RSP), with options for employee contributions and company matching.
• Flexible Spending Accounts
• educational assistance programs
• 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
• Employee Discount Program
• Employee Assistance Program (EAP)
• childcare benefits

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.

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.