Reimbursement Specialist

4 weeks ago

Houston, Texas, United States Baxter Full time

Transforming Healthcare, One Claim at a Time

Baxter is seeking a highly skilled Reimbursement Specialist to join our team. As a Reimbursement Specialist, you will play a critical role in ensuring that patients receive the medical care they need by navigating the complex world of healthcare reimbursement.

Your primary responsibility will be to perform eligibility and benefit verification, documentation collection, prior authorization and reauthorization submissions, and letter of agreement payment negotiations. You will work closely with patients, healthcare teams, and insurance companies to ensure that all necessary information is collected and submitted in a timely manner.

In this role, you will also be responsible for communicating with patients and healthcare teams to discuss payer policies, coverage criteria, benefit limitations, and potential costs. You will need to have excellent written and verbal communication skills, as well as the ability to work independently and as part of a team.

We are looking for a highly motivated and detail-oriented individual who is passionate about delivering exceptional customer service. If you have a strong background in healthcare reimbursement and are looking for a challenging and rewarding role, we encourage you to apply.

Key Responsibilities:

  • Perform eligibility and benefit verification 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
  • 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 and government payers
  • Process authorization decisions from payers in a timely manner to streamline and drive revenue
  • Negotiate payment rates for letter of agreement to ensure maximum collection potential
  • Provide a superior customer experience by discussing payer policies, coverage criteria, benefit limitations, potential costs, 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

Requirements:

  • 3+ years of experience performing eligibility and benefit verification, documentation collection, prior authorization and reauthorization submissions, preferably in health insurance, healthcare, or medical industry
  • Third-party payer experience strongly preferred
  • Exceptional written, verbal, and interpersonal communication skills
  • 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.

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