Remote Clinical Appeals Specialist

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

Benefits offered by this job

Health insurance

Dental coverage

Disability insurance

Retirement benefits

Employee stock purchase plan

Job summary

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.

Qualifications

• 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.

Responsibilities

• 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.

Skills

Clinical documentation

Communication skills

Multitasking

Time management

Critical thinking

Education

Nursing licensure

Associate degree or higher

Tools

Microsoft Office

Job description

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.