Spec, File Resolution

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 from intake through billing and collections to identify the gaps preventing reimbursement and provide a summary for resolution. Utilize various investigational tools such as Lexus Nexus, or Google to locate patient contact info, including use of classified and confidential database. Identify trends and opportunities for improvement in various processes, to increase profitability and cash flow, along with recommended solutions to the RCM Management Team. Identify files that need reactivation when escalated payer issues are resolved, and triage files to the appropriate departments, and provide direction regarding actions to take for reimbursement. Maintain a standard review and audit process for all files entering a suspended/inactive status to ensure appropriate steps have been taken before exhausting reimbursement efforts. 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 as needed to obtain current demographics, insurance, physician, and device usage, to ensure appropriate insurance reimbursement. Obtain appropriate documentation such as medical records, Medicare Advanced Beneficiary Notice (ABN), Terms Conditions Responsibility Form (TCR), and Patient Waiver Form as needed for reimbursement. Participate in various continuous improvement projects as assigned.

What You’ll Bring: Associate’s degree or higher preferred 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 Possess the ability to manage time and prioritize critical priorities Proficiency in Microsoft Office Software Experience with Total Information Management System (TIMS) a benefit 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 $60,000.00 to $82,500 annually. The estimated range is meant to reflect an anticipated salary range for the position. We may pay more or less than the anticipated range based upon market data and other factors, all of which are subject to change. Individual pay is based upon location, skills and expertise, experience, and other relevant factors. 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. 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. 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.