Spec, Insurance Discovery

Job description

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: The Spec, Insurance Discovery provides direct support to the Revenue Cycle Management Department, which includes Reimbursement Services, Cash Application, Patient Account Specialist, Billing and Collections. This position is required to collaborate cross-functionally with other Cardiology healthcare teams to coordinate and align in our mission statement of Saving and Sustaining Lives. The Spec, Insurance Discovery position requires use of data analysis tools and reporting, along with comprehensive understanding of the revenue cycle process, to analyze and resolve patient files that did not follow the standard reimbursement process. Additionally, this position will work with the management team to identify process and procedure gaps, to ensure maximum reimbursement potential. What you'll be doing: Develop a plan and/or strategy to get patient accounts back into the reimbursement process flow, either through obtaining prior authorization, performing change of insurance, and/or obtaining payment on claims. Complete complex research on patient accounts that fall into our “Error processing” process, to identify the gaps preventing reimbursement and provide a summary for resolution. Utilize various investigational tools to locate patient contact info, including use of classified and confidential databases. Ensure the accuracy of patient demographics and benefit information on file to reduce claim submission errors. Ensure claims are processed promptly, while identifying and resolving claims issues resulting in delayed processing and adjudication. Identify payer trends and establish payer-specific strategies to overcome reimbursement challenges. Analyze and work various revenue reports, including, but not limited to “claim validation,” “return billing report,” to ensure all reimbursement procedures were followed, and claims can be released to payers or funneled back into the reimbursement process or accounts are closed out in the appropriate manner. Contact patients/families/caregivers/Clients and Account Executives as needed to obtain current demographics, insurance, physician, and device usage, to ensure appropriate insurance reimbursement. Ensure timely follow-up and follow-through of errors received and authorizations initiated. Establish and maintain positive partnerships with sales team and other internal and external Cardiology Healthcare teams. Provide effective and superior customer service by leveraging ability to discuss payer policies, coverage criterion, or any pertinent plan or product information with patients, sales team, and other internal and external Cardiology Healthcare teams. Consistently meets productivity while understanding how they support greater organizational goals. Actively seek additional experience and knowledge across all functional areas to gain expertise. Provide workload coverage as needed. Understand and adhere to all policies for Baxter and third-party payers to ensure the highest standards of quality and compliance. Perform other duties and projects as assigned. What you'll bring: High school diploma or equivalent required, associate’s degree or higher preferred. 2+ years of healthcare related experience in the revenue cycle process with a specialized focus around eligibility and benefit verification, claims submission. Cardiology related experience a plus. Knowledge of insurance industry and third-party payer processes Excellent data entry skills required Ability to organize and prioritize workload Strong attention to detail while balancing high volume data entry Proficiency in Microsoft Office software Knowledge of Federal, State, and Local regulations, guidelines, and standards, including a working knowledge of HIPAA rules and regulations. Third-party payer experience strongly preferred. Experience with medical record reviews to identify and ensure medical necessity preferred Excellent customer service skills. The ability to deescalate conflict effectively and quickly as it arises, a plus. Strong critical thinking and problem-solving skills. 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 $44,800 - $61,600 annually. The estimated range is meant to reflect an anticipated salary range for the position. We may pay more or less than of the anticipated range based upon market data and other factors, all of which are subject to change. Individual pay is based on upon location, skills and expertise, experience, and other relevant factors. This position may also be eligible for discretionary bonuses. 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. ​ Applicants must be authorized to work for any employer in the U.S. We are unable to sponsor or take over sponsorship of an employment visa at this time. US Benefits at Baxter (except for Puerto Rico) This is where your well-being matters. Baxter offers comprehensive compensation and benefits packages for eligible roles. Our health and well-being benefits include medical and dental coverage that start on day one, as well as insurance coverage for basic life, accident, short-term and long-term disability, and business travel accident insurance. Financial and retirement benefits include the Employee Stock Purchase Plan (ESPP), with the ability to purchase company stock at a discount, and the 401(k) Retirement Savings Plan (RSP), with options for employee contributions and company matching. We also offer Flexible Spending Accounts, educational assistance programs, and time-off benefits such as paid holidays, paid time off ranging from 20 to 35 days based on length of service, family and medical leaves of absence, and paid parental leave. Additional benefits include commuting benefits, the Employee Discount Program, the Employee Assistance Program (EAP), and childcare benefits. Join us and enjoy the competitive compensation and benefits we offer to our employees. For additional information regarding Baxter US Benefits, please speak with your recruiter or visit our Benefits site: Benefits | Baxter 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. Know Your Rights: Workplace Discrimination is Illegal 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 link 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 Recruitment Fraud Notice .