Spec, Reimbursement

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: In this role you will perform Reimbursement Specialist duties for assigned territory or payer(s) including eligibility and benefit verification, documentation collection, prior authorization and reauthorization submissions, letter of agreement payment negotiations, and processing payer decisions. As the Reimbursement Specialist you will communicate directly with patients, healthcare teams, and insurance companies as well as collaborating cross-functionally with teams to coordinate in our mission of enhancing outcomes for patients and their caregivers. This is a full-time hybrid position where the candidate would report to the St. Paul office three days a week, Monday through Friday. The hours of operation are 8:00am-4:30pm CST.

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 Cardiology products and 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. Ensure compliance with Federal Medicare, State Medicaid, and Third-Party requirements for in-state brick and mortar regulations, including but not limited to: Staff and maintain required brick and mortar location during the posted business hours, including answering of phone calls to site. Organize and update state licensure information and other appropriate documentation to ensure it is in available upon audit of site. Manage external audits from CHAP, Medicare, Medicaid, and licensing agencies. Enter orders, provide confirmation notices, and follow-up with Healthcare Teams to obtain valid order requirements, as needed.

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. Baxter is committed to supporting the needs for flexibility in the workplace. We do so through our flexible workplace policy which includes a minimum