Claims & Appeals Specialist Job at Baxter (Saint Paul)

Medical Billing Specialist

We are looking for a detail-oriented Medical Billing Specialist to join a team i...

Location

United States , King of Prussia

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

At least 1 year of experience in medical billing, claims, or collections
Proficiency in accounting software systems and electronic health record (EHR) systems
Familiarity with Medicaid processes and commercial insurance claims
Strong understanding of accounts receivable, denial management, and appeals
Experience working with billing and authorization functions
Ability to accurately input and manage billing data
Excellent communication skills to collaborate with team members and external payors
Knowledge of compliance policies related to medical billing and collections

Job Responsibility

Process and submit primary and secondary claims for both commercial insurance and Medicaid
Investigate and resolve claim denials, performing appeals as necessary to ensure proper reimbursement
Manage accounts receivable by following up on claims through resolution, including correcting billing errors and addressing rejections
Input and review billing data for accuracy, ensuring compliance with company policies and procedures
Collaborate with the Billing Manager and clinic teams to ensure accurate and timely billing
Track and verify Medicaid status for clients while maintaining relationships with payors to facilitate successful claims processing
Assist intake teams with Medicaid documentation for new clients and those requiring reassessment
Utilize various insurance portals and systems, including Waystar, to handle denial responses and claims follow-ups
Ensure adherence to compliance standards in all billing and collections activities
Perform other tasks as assigned by the Billing Manager or Director

What we offer

Medical insurance
Vision insurance
Dental insurance
Life insurance
Disability insurance
401(k) plan

Fulltime

Medical Reimbursement Specialist

We are in search of a Medical Reimbursement Specialist to join our team. Station...

Location

United States , Princeton

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Minimum of 3 years of experience in a similar role
Proficient in benefit functions
Demonstrated expertise in billing functions
Experience in claim administration
Familiarity with collection processes
Ability to handle and resolve medical denials
Comprehensive knowledge of Medicare

Job Responsibility

Analyze and categorize outstanding claims based on payer, denial reason, and claim value
Investigate and take corrective action on unpaid, denied, or underpaid claims
Collaborate with internal teams to obtain missing documentation and expedite claim resubmission
Evaluate common denial reasons and address them accordingly, such as coding errors, medical necessity, and prior authorization
Submit corrected claims and formal appeals as required
Communicate with insurance payers to resolve aged claims and escalate unresolved claims as necessary
Maintain comprehensive records of all payer interactions
Identify the root causes of denials and implement best practices to prevent future issues
Suggest changes to workflow to enhance claim submission accuracy and speed
Conduct training for in-house billing teams on claim recovery strategies

What we offer

medical, vision, dental, and life and disability insurance
eligibility to enroll in company 401(k) plan

Fulltime

Appeals Specialist I

Responsible for all activities associated with requests for Provider Billing Dis...

Location

United States , Portland

Salary:

25.00 - 30.00 USD / Hour

Apex Systems

Expiration Date

Until further notice

Requirements

Excellent verbal and written communication skills
Intermediate computer skills (e.g. Microsoft Word, Excel, Outlook)
Knowledge of medical terminology, anatomy and coding (CPT, DX, HCPCs)
Knowledge of claims processing and clinical services operations
Demonstrated initiative and analytical ability in identifying problems, researching issues, developing solutions, and implementing a course of action
Ability to listen and communicate appropriately in a manner that promotes positive, professional interaction while maintaining confidentiality and sensitivity in all aspects of internal and external contacts
Ability to present complex medical and reimbursement information to others and to be diplomatic and persuasive regarding health plan benefits, claims and eligibility
Ability to switch from one task or type of work to another as the business needs require
Ability to effectively prioritize work to meet strict timelines while maintaining quality and consumer centric focus
High school diploma or GED and a minimum 4 years’ experience in customer Service, Claims, or Clinical Services or equivalent combination of education and work experience

Job Responsibility

Responsible for all activities associated with appeal analysis, decision-making and closure
Appeal Intake – Validate intake determinations regarding timeliness, member benefits, employer group, and provider contract provisions for each appeal. Document information in appropriate system
Appeal Analysis – Review claim coding and claim processing history, medical policy and reimbursement policies, regulatory and legal requirements, benefit contracts, and/or provider contracts. Collect and catalogue supporting documentation and formulate an appeal recommendation. Document information in appropriate system. Apply knowledge and experience to answer a variety of increasingly complex inquiries from members, providers, and provider representatives. Collaborate effectively with coding specialists, appeal nurses, physician reviewers, and others as necessary to reach timely decisions on appeals
Decision & Closure – Make non-clinical appeal determinations as permitted by department business processes and guidelines. Follow department’s processes to receive a clinical review and decision from licensed health professionals. Present complex cases to appeal panels, document decisions, communicate determinations to members, providers or their representatives. Document information in appropriate system(s)
External review process – Oversee set-up of appeals for external review organizations, including document collection and coordination, communication with all parties, and other responsibilities as an intermediary between the provider and the external review organization. Ensure external review information is documented in appropriate system. Prepares letters and cases for external review as needed. Implement external review decisions
Interpersonal and Communication – Provide information, education and assistance to members, providers, and their representatives. Facilitate the member’s or provider’s’ understanding of the appeal process and of the information necessary to effectively process an appeal. Be a courteous advocate to the member or provider when requesting supporting information. Work cooperatively and effectively across all business areas to resolve
Systems and data – Track appeals in appropriate systems and assist in the maintenance of files. Assist with compilation of reports on appeals, including trends, number of cases, decisions, suggestions for process improvement, types of appeals, and compliance with timelines
Support, apply and promote Provider or Member Appeal Policies & Procedures
Adhere to dependability, customer focus, and all performance criteria as established by the department including: timeliness, production, and quality standards for all work
Manage a defined caseload within department productivity and quality expectations and provide back up for other appeals staff

What we offer

Medical, dental, vision, life, disability, and other insurance plans
ESPP (employee stock purchase program)
401K program with company match after 12 months
HSA (Health Savings Account on the HDHP plan)
SupportLinc Employee Assistance Program (EAP) with up to 8 free counseling sessions
Corporate discount savings program
On-demand training program
Access to certification prep and a library of technical and leadership courses/books/seminars after 6+ months of tenure
Certification discounts and other perks to associations that include CompTIA and IIBA
Dedicated customer service team for Consultants

Fulltime

New

Medical Claims Resolution Specialist

We are seeking a detail-oriented Medical Claims Resolution Specialist within the...

Location

United States , Indianapolis

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

2+ years of experience in medical billing, claims resolution, accounts receivable, or revenue cycle operations
Must reside in the state of Indiana

Job Responsibility

Review and analyze denied, rejected, or outstanding medical claims to identify root causes
Research claim discrepancies, billing issues, coding errors, and payer requirements
Communicate with insurance companies, patients, and internal departments to resolve claim issues efficiently
Submit corrected claims, appeals, and supporting documentation as needed
Track claim status and maintain accurate documentation of follow-up actions and resolutions
Ensure compliance with payer guidelines, HIPAA, and company policies
Collaborate with billing, coding, and revenue cycle teams to improve claim resolution processes
Identify trends in denials and recommend process improvements

What we offer

medical
vision
dental
life and disability insurance
401(k) plan

Fulltime

Appeals Specialist

We are looking for an experienced Appeals Specialist to join our team on a contr...

Location

United States , Lynnwood

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Experience in claims processing or healthcare patient services/customer service is preferred
Familiarity with healthcare industry platforms
Strong proficiency in data entry
Demonstrated ability to work effectively in a Windows-based PC environment
Excellent multitasking and organizational skills to manage workloads efficiently
Strong attention to detail with a focus on meeting productivity and quality benchmarks

Job Responsibility

Review and analyze incoming mail and faxes to route them to the appropriate recipient
Conduct thorough research using reference materials, online tools, and proprietary systems
Enter and manage new cases in the system, ensuring all production goals are consistently met
Accurately identify and prioritize expedited appeal requests for timely processing
Respond to appeals that require claimant authorization, adhering to all privacy guidelines
Validate and handle privacy-related tasks, including processing authorizations and managing confidential documents
Assist with office supply orders and scheduling appeal panels as needed
Help the department meet quality and productivity standards through teamwork and individual contributions
Perform additional tasks as assigned to support overall team goals

What we offer

medical, vision, dental, and life and disability insurance
eligible to enroll in our company 401(k) plan

Claims Resolution Representative III

The Claims Resolution Representative III is responsible for working across the p...

Location

United States of America , Rochester

Salary:

19.62 - 26.49 USD / Hour

University of Rochester

Expiration Date

Until further notice

Requirements

Associate degree and 2 years of related relevant experience
or equivalent combination of education and/or experience
Excellent problem-solving skills
Excellent communication skills
Excellent customer service skills

Job Responsibility

Follows department policies and procedures and maintains and exercises comprehensive knowledge of insurance company billing requirements and regulations to research and resolve unpaid accounts receivable
Follows up on multi-faceted denials through review of remittances (EOBs), insurance correspondence, rejections
Research claims, identify problems, and take appropriate action to assure claim resolution
Responds to all billing-related inquiries from colleagues, departments, patients, and payors in a timely and professional manner
Communicates any missing/incomplete information to providers and department administrative support staff to ensure accurate billing
Communicates with insurance representatives through telephone calls, payer website, and written communication to ensure accurate processing of claims
Collaborate with appropriate departments to generate a detailed rational for appeals and grievances to the insurance companies
Keeps management informed of changes in billing requirements and rejection or denial codes as they pertain to claim processing and coding
Escalates system issues preventing claims submission and follow-up for review and resolution
Collaborates with Claim Edit Specialists and Patient Medical Billing Specialists assigned to pre claim WQ’s to identify opportunities for improvement in clean claims rate

Fulltime

Medical Billing and Payment Posting Specialist

Our client has an immediate need for a Medical Billing and Payment Posting Speci...

Location

United States , Spring

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

2+ years of medical billing, payment posting, or revenue cycle experience
Experience working with Athena (athenaOne or athenaCollector) preferred
Strong understanding of EOBs, claim submissions, and denial management
Experience posting insurance payments, adjustments, and charge tickets
Ability to reconcile payment activity and maintain accurate billing records
Strong attention to detail and ability to manage multiple claims and accounts

Job Responsibility

Post insurance payments and adjustments from Explanation of Benefits (EOBs) into Athena, including denial codes, notes, and supporting documentation
Reconcile daily payment activity by preparing spreadsheets and validating totals against transactions recorded in Athena
Verify electronic claim transmissions through Athena and ensure successful submission to insurance carriers
Enter and post charge tickets, cash receipts, and program payments within Athena and route deposits and documentation to bookkeeping as needed
Review medical bills for covered services and claim accuracy prior to submission to private insurers, government programs, and third-party payers
Monitor unpaid or denied claims within Athena work queues and follow up appropriately, including rebilling when necessary
Research discrepancies and assist with claim corrections and appeals for denied or underpaid claims
Maintain and update patient account information, including address changes and program coverage verification
Respond to patient and provider inquiries regarding charges, statements, and medical billing questions
Conduct outbound calls to patients, providers, and insurance carriers to resolve billing issues and confirm claim status

What we offer

medical, vision, dental, and life and disability insurance
eligible to enroll in our company 401(k) plan

Fulltime

Medical Billing and Payment Posting Specialist

Our client has an immediate need for a Medical Billing and Payment Posting Speci...

Location

United States , Spring

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

2+ years of medical billing, payment posting, or revenue cycle experience
Experience working with Athena (athenaOne or athenaCollector) preferred
Strong understanding of EOBs, claim submissions, and denial management
Experience posting insurance payments, adjustments, and charge tickets
Ability to reconcile payment activity and maintain accurate billing records
Strong attention to detail and ability to manage multiple claims and accounts

Job Responsibility

Post insurance payments and adjustments from Explanation of Benefits (EOBs) into Athena, including denial codes, notes, and supporting documentation
Reconcile daily payment activity by preparing spreadsheets and validating totals against transactions recorded in Athena
Verify electronic claim transmissions through Athena and ensure successful submission to insurance carriers
Enter and post charge tickets, cash receipts, and program payments within Athena and route deposits and documentation to bookkeeping as needed
Review medical bills for covered services and claim accuracy prior to submission to private insurers, government programs, and third-party payers
Monitor unpaid or denied claims within Athena work queues and follow up appropriately, including rebilling when necessary
Research discrepancies and assist with claim corrections and appeals for denied or underpaid claims
Maintain and update patient account information, including address changes and program coverage verification
Respond to patient and provider inquiries regarding charges, statements, and medical billing questions
Conduct outbound calls to patients, providers, and insurance carriers to resolve billing issues and confirm claim status

What we offer

medical, vision, dental, and life and disability insurance
eligible to enroll in our company 401(k) plan

Claims & Appeals Specialist

Baxter

Location:
United States , Saint Paul

Category:
Finance

Contract Type:
Not provided

Salary:

Job Description:

Job Responsibility:

Requirements:

Nice to have:

Additional Information:

Job Posted:
March 02, 2026

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Claims & Appeals Specialist

Baxter

Location:United States , Saint Paul

Category:Finance

Contract Type:Not provided

Salary:

Job Description:

Job Responsibility:

Requirements:

Nice to have:

Additional Information:

Job Posted:March 02, 2026

Looking for more opportunities? Search for other job offers that match your skills and interests.

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Location:
United States , Saint Paul

Category:
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Contract Type:
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Job Posted:
March 02, 2026