Clinical Appeals Advocate

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🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $60k - $82.5k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 0%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Baxter International Inc.

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

🏭 Manufacturing

⚕️ Healthcare Insurance

💰 Grant on 2021-04

Healthcare • Manufacturing • Healthcare Insurance

Baxter International Inc. is an innovative, global healthcare leader that offers advanced products, technologies, and therapies to support people in leading healthier, longer lives. The company is committed to meeting the challenges faced by patients, clinicians, and customers in the evolving healthcare landscape, emphasizing resilience and a mission to save and sustain lives.

📋 Description

• Assess cases, develop appeal strategies, gather clinical documentation, and prepare persuasive appeal submissions for commercial and government payers • Communicate with patients to explain appeal strategies, outline their responsibilities, and support preparation for hearings when applicable • Create clinical case summaries and strengthen documentation for challenging payers or strict coverage criteria • Process favorable appeal decisions promptly, negotiate payment rates through letters of agreement, and determine appropriate resolutions when denials are upheld • Build and maintain professional relationships with case managers and medical directors to promote positive patient outcomes • Discuss payer policies, coverage criteria, benefit limitations, potential costs, and product information with patients and healthcare teams • Ensure adherence to Hillrom and third-party payer policies while maintaining quality, compliance, and team contribution • Seek ongoing learning opportunities, support workload coverage, and perform additional duties or projects as assigned

🎯 Requirements

• Registered Nurse (RN), Respiratory Therapist (RT), or Licensed Practical Nurse (LPN) required, with active state licensure or certification • Associate degree or higher, or equivalent work experience in a related clinical or reimbursement field • Minimum of 3 years of experience reviewing medical records and securing third-party reimbursement preferred • Knowledge of federal, state, and local regulations, including HIPAA requirements and payer guidelines • Exceptional written, verbal, and interpersonal communication skills with strong attention to detail • Ability to multitask effectively, prioritize critical responsibilities, and manage time independently • Strong critical-thinking and problem-solving abilities, with comfort working both independently and within a team • Proficiency in Microsoft Office and related software tools • Applicants must be authorized to work for any employer in the U.S.; employment visa sponsorship is unavailable

🏖️ Benefits

• Medical and dental coverage starting on day one • Basic life, accident, short-term and long-term disability, and business travel accident insurance • Employee Stock Purchase Plan (ESPP) with discounted company stock • 401(k) Retirement Savings Plan (RSP) with employee contributions and company matching • Flexible Spending Accounts • Educational assistance programs • Paid holidays • Paid time off ranging from 20 to 35 days based on length of service • Family and medical leaves of absence • Paid parental leave • Commuting benefits • Employee Discount Program • Employee Assistance Program (EAP) • Childcare benefits • Reasonable accommodations for individuals with disabilities

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