Spec, File Resolution

This is whereyour work makes a difference.

At Baxter we believe every personregardless of who they are or where they are fromdeserves 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 jobyou will find purpose and pride.

Your role at Baxter

The File Resolution Specialist is responsible for providing direct support to the Revenue Cycle Management Department which includes Reimbursement Services Medicare Billing and Collections Teams. This position requires use of data analysis tools and reporting along with comprehensive understanding of the revenue cycle 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 youll 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 Youll Bring

• Associates 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 orientated 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.

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 $60000.00to $82500 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. 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 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

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