Spec, File Resolution

Baxter International; Saint Paul (MN); Hybrid; USD 60,000 - 83,000; Full time

Job summary

A leading healthcare company is seeking a File Resolution Specialist to support the Revenue Cycle Management Department. This role involves analyzing patient files, identifying gaps in reimbursement processes, and directly engaging with patients for information required for reimbursement. The ideal candidate should have at least 3 years of experience in health insurance or related fields, exceptional problem-solving skills, and proficiency in Microsoft Office. This position includes a flexible workplace policy with a minimum of 3 days onsite per week.

Benefits

Medical and dental coverage

401(k) Retirement Savings Plan

Paid time off ranging from 20 to 35 days

Qualifications

• 3+ years of industry experience, preferably in health insurance or durable medical equipment.
• Third party payer experience strongly preferred.
• Ability to manage time and prioritize tasks.

Responsibilities

• Develop plans to integrate patient accounts into the reimbursement process.
• Conduct complex research on patient accounts.
• Contact patients to obtain current demographics and insurance information.

Skills

Critical thinking

Problem-solving skills

Detail oriented

Interpersonal communication

Multi-tasking

Education

Associates degree or higher

Tools

Microsoft Office

Total Information Management System (TIMS)

Job description

This is whereyour 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

The File Resolution Specialist is responsible for providing direct support to the Revenue Cycle Management Department, which includes Reimbursement Services, Medicare, Billing and Collections Teams. This position requires use of data analysis tools and reporting, along with comprehensive understanding of the revenue cycle, to analyze and resolve patient files that did not follow the standard reimbursement process. Additionally, this position will work with the management team to identify process and procedure gaps, to ensure maximum reimbursement potential.

What You’ll Be Doing

• Develop a plan and/or strategy to get patient accounts back into the reimbursement process flow, either through obtaining prior authorization, performing change of insurance, and/or obtaining payment on claims.
• Complete complex research on patient accounts from intake, through billing and collections, to identify the gaps preventing reimbursement, and provide a summary for resolution.
• Utilize various investigational tools such as Lexus Nexus, or Google to locate patient contact info, including use of classified and confidential database.
• Identify trends and opportunities for improvement in various processes, to increase profitability and cash flow, along with recommended solutions to the RCM Management Team.
• Identify files that need reactivation when escalated payer issues are resolved, and triage files to the appropriate departments, and provide direction regarding actions to take for reimbursement.
• Maintain a standard review and audit process for all files entering a suspended/inactive status to ensure appropriate steps have been taken before exhausting reimbursement efforts.
• Analyze and work various revenue reports, including, but not limited to “claim validation”, “return billing report”, to ensure all reimbursement procedures were followed, and claims can be released to payers or funneled back into the reimbursement process or accounts are closed out in the appropriate manner.
• Contact patients/families/caregivers as needed to obtain current demographics, insurance, physician, and device usage, to ensure appropriate insurance reimbursement.
• Obtain appropriate documentation such as medical records, Medicare Advanced Beneficiary Notice (ABN), Terms Conditions Responsibility Form (TCR), and Patient Waiver Form as needed for reimbursement.
• Participate in various continuous improvement projects as assigned.

What You’ll Bring

• Associates degree or higher preferred
• 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 oriented 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

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.

We understand compensation is an important factor as you consider the next step in your career. At Baxter, we are committed to equitable pay for all employees, and we strive to be more transparent with our pay practices. The estimated base salary for this position is $60,000.00 to $82,500 annually. The estimated range is meant to reflect an anticipated salary range for the position. We may pay more or less of the anticipated range based upon market data and other factors, all of which are subject to change. Individual pay is based on location, skills and expertise, experience, and other relevant factors. For questions about this, our pay philosophy, and available benefits, please speak to the recruiter if you decide to apply and are selected for an interview.

US Benefits at Baxter (except for Puerto Rico)

This is where your well-being matters. Baxter offers comprehensive compensation and benefits packages for eligible roles. Our health and well-being benefits include 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. Financial and retirement benefits include the 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. We also offer Flexible Spending Accounts, educational assistance programs, and 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. Additional benefits include commuting benefits, the Employee Discount Program, the Employee Assistance Program (EAP), and childcare benefits. Join us and enjoy the competitive compensation and benefits we offer to our employees. For additional information regarding Baxter US Benefits, please speak with your recruiter or visit our Benefits site: Benefits | Baxter.

Equal Employment Opportunity

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.

Reasonable Accommodations

Baxter is committed to working with and providing reasonable accommodations to individuals with disabilities globally. If, because of a medical condition or disability, you need a reasonable accommodation for any part of the application or interview process, please click on the link here and let us know the nature of your request along with your contact information.

Recruitment Fraud Notice

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