- Assess cases, develop appeal strategies, and set timelines to ensure appeal deadlines are met for Respiratory Health supply and accessory appeals.
- Gather clinical documentation to support medical necessity for Respiratory Health supplies and accessories.
- Prepare and submit persuasive appeal/reconsideration requests to insurance companies including commercial and government payers such as Medicare and Medicaid for Respiratory Health supply and accessory appeals.
- Process favorable supply/accessory appeal decisions from payers timely to streamline and drive revenue.
- Identify appropriate resolution for accounts if supply/accessory denial is upheld by payer including supply strategy cross department collaboration with the managed care teams.
- Assist Appeal team advocates with following up on outstanding requests for additional documentation from healthcare teams and/or patients and follow up on appeal/reconsideration determinations from insurance companies.
- Request authorization updates as needed on approved appeal cases to prepare for billing.
- Understand and adhere to all policies for Baxter and 3rd party payers to ensure the highest standards of quality and compliance.
- Consistently contribute to team goals and understand how they support greater organizational goals.
- Actively seek additional experience and knowledge across all functional areas to gain expertise.
- Provide workload coverage as needed.
- Perform other duties and projects as assigned.
- 1+ years industry experience (3rd party payer or DME provider) strongly preferred.
- Knowledge of federal, state, and local regulations, guidelines, and standards, including a working knowledge of HIPAA rules and regulations
- Exceptional written, verbal, and interpersonal communication skills
- Detail oriented and ability to multi-task.
- Strong critical thinking and problem-solving skills
- Ability to work independently as well as in a team environment.
- Possess ability to manage time and prioritize critical priorities.
- Proficiency in Microsoft Office Software
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Clinical Appeals Coordinator - St. Paul, United States - Hillrom
Description
This is where you save and sustain lives
At Baxter, we are deeply connected by our mission. No matter your role at Baxter, your work makes a positive impact on people around the world. You'll feel a sense of purpose throughout the organization, as we know our work improves outcomes for millions of patients.
Baxter's products and therapies are found in almost every hospital worldwide, in clinics and in the home. For over 85 years, we have pioneered significant medical innovations that transform healthcare.
Together, we create a place where we are happy, successful and inspire each other. This is where you can do your best work.
Join us at the intersection of saving and sustaining lives- where your purpose accelerates our mission.
Your role at Baxter
THIS IS WHERE you build trust to achieve results...
The Clinical Appeals Coordinator is responsible for assisting and supporting the Appeals department whose main function includes providing advocacy support to patients who are denied coverage for Baxter Respiratory Health products. The role communicates directly with patients, healthcare teams, and insurance companies as well as collaborating cross-functionally with other Respiratory Health teams to coordinate in our mission to save and sustain lives.
What you'll be doing
What you'll bring
#LI-DF1
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 $41,600 to $57,200 annually. The estimated range is meant to reflect an anticipated salary range for the position. We may pay more or less than the anticipated range based upon market data and other factors, all of which are subject to change. Individual pay is based upon 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.
The successful candidate for this job may be required to verify that he or she has been vaccinated against COVID-19, subject to reasonable accommodations for individuals with medical conditions or religious beliefs that prevent vaccination, and in accordance with applicable law.
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.
EEO is the Law
EEO is the law - Poster Supplement
Pay Transparency Policy
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 here and let us know the nature of your request along with your contact information.
Recruitment Fraud Notice
Baxter has discovered incidents of employment scams, where fraudulent parties pose as Baxter employees, recruiters, or other agents, and engage with online job seekers in an attempt to steal personal and/or financial information. To learn how you can protect yourself, review our .
Hillrom is an equal employment employer F/M/Disability/Vet/Sexual Orientation/Gender Identity. Please click To view the EEO is the Law poster.
