Reimbursement Specialist

1w1 week ago

Baxter International Inc.

US · Full-time · $49,600 – $68,200

About this role

At Baxter, our mission to Save and Sustain Lives unites colleagues in a culture of courage, trust, and collaboration. As Reimbursement Specialist, you build trust to achieve results by performing duties for assigned territory or payers, including eligibility verification and prior authorizations. You communicate directly with patients, healthcare teams, and insurance companies.

You verify eligibility and benefits to determine coverage requirements, ensuring information loads correctly for clean claims. Gather clinical documentation for Cardiology products to meet medical necessity criteria like prescriptions and face-to-face encounters. Prepare submissions to commercial payers, Medicare, and Medicaid, then process decisions timely to drive revenue.

Negotiate letter of agreement payment rates for maximum collections while providing superior customer experience on payer policies and coverage. This full-time hybrid role reports to the St. Paul office three days weekly, Monday-Friday 10am-6pm CST. Cross-functionally collaborate to enhance outcomes for patients and caregivers.

Here, find more than a job—purpose and pride in redefining healthcare delivery. Baxter's flexible workplace policy requires minimum three days onsite to support in-person connection and mission. Every individual takes ownership for efficient operations and exceptional results.

Requirements

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
Ability to manage time and prioritize critical priorities
Proficiency in Microsoft Office Software

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 Cardiology products and assess for prescription, face-to-face, and coverage criteria requirements
Prepare and submit prior authorization requests to insurance companies including commercial payers, 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 superior customer experience by discussing payer policies, coverage criteria, benefit limitations, potential cost, or product information with patients and healthcare teams
Understand and adhere to all policies for Baxter and 3rd party payers to ensure highest standards of quality and compliance