Spec, insurance verification

• Develop a flawless strategy to reintegrate patient accounts into the reimbursement process, either through acquiring prior authorization, performing change of insurance, or securing payment on claims
• Perform detailed research on patient accounts within our “Error processing” process to identify gaps hindering reimbursement and offer a comprehensive summary for resolution
• Apply outstanding investigational tools to find patient contact information, including classified and confidential databases
• Ensure the accuracy of patient demographics and benefit information on file to minimize claim submission errors
• Process claims promptly, identifying and resolving issues causing delayed processing and adjudication
• Identify payer trends and implement payer-specific strategies to overcome reimbursement challenges
• Review revenue reports like "claim validation" and "return billing report" to ensure reimbursement procedures are followed
• Contact patients, families, and caregivers as needed to acquire current demographics, insurance, physician, and device usage information to ensure appropriate insurance reimbursement
• Ensure timely follow-up and completion of errors received and authorizations initiated
• Foster and uphold favorable relationships with the sales team and other internal and external Cardiology Healthcare teams
• Offer outstanding customer service through discussions on payer policies, coverage criteria, or relevant plan and product information with patients, sales team, and other internal and external Cardiology Healthcare teams
• Consistently meet efficiency goals while understanding their support for greater organizational objectives
• Actively seek additional experience and knowledge across all functional areas to gain expertise
• Provide workload coverage as needed
• Understand and adhere strictly to all policies for Baxter and third-party payers, ensuring the highest standards of quality and compliance
• Perform other duties and projects as assigned

• High school diploma or equivalent experience required, associate’s degree or higher preferred
• 2-3 years of healthcare-related experience in the revenue cycle process with a specialized focus on eligibility and benefit verification, and claims submission
• Knowledge of Federal, State, and Local regulations, guidelines, and standards, including a working knowledge of HIPAA rules and regulations
• Proven third-party payer experience is strongly preferred
• Experience with medical record reviews to identify and ensure medical necessity
• Outstanding written, verbal, and interpersonal communication skills
• Excellent customer service skills with the ability to deescalate conflict effectively and quickly
• Strong critical thinking and problem-solving abilities
• Diligent and capable of multitasking
• Ability to work independently and as part of a team
• Ability to manage time and prioritize critical tasks
• Proficiency in Microsoft Office Software

Cardiology-related experience is a plus

• Support for parents
• Continuing education/ Professional development
• Employee health and Wellness benefits
• Paid time off
• 2 days per year to volunteer
• Medical and dental coverage that start on day one
• Insurance coverage for basic life, accident, short-term and long-term disability, and business travel accident insurance
• Employee Stock Purchase Plan (ESPP)
• 401(k) Retirement Savings Plan (RSP)
• 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