Clinical Appeals Advocate

As a Clinical Appeals Advocate you will serve as a key patient advocatesupporting individuals who have been denied insurance coverage for Baxters Respiratory Health products. You will work directly with patients healthcare teams and insurance payers to overturn denials secure access to medically necessary therapies and advance our Mission to Save and Sustain Lives.

This role requires strong clinical understanding excellent communication skills and the ability to navigate complex payer policies. You will collaborate crossfunctionally with Respiratory Health teams build relationships with case managers and medical directors and ensure a superior experience for patients throughout the appeals process.

This is a remote position based in the United States.

What youll be doing

• 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 those with 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.

• Deliver a superior customer experience by discussing payer policies coverage criteria benefit limitations potential costs and product information with patients and healthcare teams.

• Ensure adherence to Hillrom and thirdparty payer policies while maintaining high standards of quality compliance and team contribution.

• Seek ongoing learning opportunities support workload coverage and perform additional duties or projects as assigned.

What youll bring

• 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 thirdparty 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 criticalthinking and problemsolving abilities with comfort working both independently and within a team.

• Proficiency in Microsoft Office and related software tools.

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 $60000to $82500annually. 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.

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.