Remote Clinical Appeals Specialist

Baxter International Inc.; United States; Remote; USD 60,000 - 83,000; Full time

Benefits offered by this job

Health and dental coverage from day 1

Life insurance

Short-term and long-term disability

Employee Stock Purchase Plan (ESPP)

401(k) Retirement Savings Plan

Paid holidays

Paid time off 20–35 days

Paid parental leave

Flexible spending accounts

Education assistance

Commuting benefits

Employee discount program

Employee assistance program (EAP)

Job summary

Baxter International Inc. is seeking a Clinical Appeals Advocate to support patients denied insurance coverage for Respiratory Health products.

You will work with patients, healthcare teams, and payers to overturn denials and secure access to therapies, contributing to Baxter's mission to save and sustain lives. The role requires clinical understanding, outstanding communication, and the ability to navigate payer policies.

Qualifications

• RN/RT/LPN with active state licensure required.
• Associate degree or higher in a clinical or reimbursement field.
• Minimum 3 years of experience reviewing medical records and securing third-party reimbursement.
• Knowledge of HIPAA regulations and payer guidelines.
• Excellent written, verbal, and interpersonal communication skills.
• Ability to multitask, prioritize responsibilities, and manage time independently.
• Strong critical-thinking and problem-solving abilities.
• Proficiency in Microsoft Office.

Responsibilities

• Assess cases, develop appeal strategies, gather documentation, and prepare submissions for payers.
• Communicate with patients to explain appeal strategies and prepare for hearings when applicable.
• Create clinical case summaries and strengthen documentation for challenging payers.
• Process favorable decisions promptly, negotiate payments, and determine resolutions when denials stand.
• Build relationships with case managers and medical directors to promote positive outcomes.
• Deliver a superior customer experience by discussing payer policies, coverage criteria, and product information.
• Ensure adherence to Baxter policies and maintain high standards of quality and compliance.
• Seek learning opportunities and support workload coverage; perform additional duties as assigned.

Skills

Communication skills

Attention to detail

Multitasking

Teamwork

Microsoft Office

Education

Associate degree or higher

Tools

Microsoft Office

Job description

Baxter International Inc. is seeking a Clinical Appeals Advocate to support patients denied insurance coverage for Respiratory Health products.

You will work with patients, healthcare teams, and payers to overturn denials and secure access to therapies, contributing to Baxter's mission to save and sustain lives. The role requires clinical understanding, outstanding communication, and the ability to navigate payer policies.