Description
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.
As a Reimbursement Specialist, you will be responsible for duties in an 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 other Respiratory Health teams to coordinate in our mission of enhancing outcomes for patients and their caregivers.
Responsibilities
- 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 Respiratory Health products.
- 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.
- 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 and perform other duties and projects as assigned.
Qualifications
- 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.
