Remote Clinical Appeals Advocate

Baxter International Inc.; Oregon; Ibrido; USD 60.000 - 83.000; Tempo pieno

Vantaggi offerti da questo lavoro

Health benefits

401(k) matching

Remote work

Descrizione del lavoro

Baxter International Inc. is seeking a Clinical Appeals Advocate to support patients whose insurance denials affect access to Respiratory Health products. You will work with patients, healthcare teams, and payers to overturn denials, secure access, and advance our mission to save and sustain lives.

The role requires clinical understanding, strong communication, and the ability to navigate payer policies. This is a remote US-based position with comprehensive benefits and competitive compensation.

Competenze

• 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.

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

Nursing license

RN/RT/LPN

Associate degree

3+ years experience

HIPAA knowledge

Strong communication

Multitasking

Critical thinking

MS Office

Payer guidelines

Formazione

Associate degree

Strumenti

Microsoft Office

Descrizione del lavoro

Baxter International Inc. is seeking a Clinical Appeals Advocate to support patients whose insurance denials affect access to Respiratory Health products. You will work with patients, healthcare teams, and payers to overturn denials, secure access, and advance our mission to save and sustain lives.

The role requires clinical understanding, strong communication, and the ability to navigate payer policies. This is a remote US-based position with comprehensive benefits and competitive compensation.