Medical Records and Authorization Specialist Job at Baxter (Houston)

Job Description

As a member of the Baxter Finance team, you have the critical thinking and analytical mindset that allows you to translate data into meaningful, actionable insights that help teams learn and adapt along the way. We guide our internal partners to understand financial opportunities or realities that move Baxter forward and closer to our mission to save and sustain lives. While you often work independently with your cross-functional team, you always have the greater finance organization to lean on for support and career mentoring.

Job Responsibility

Perform Medical Records and Authorization Specialist duties including documentation collection and review, prior authorization and reauthorization submissions
Communicate directly with client medical records depts, patients, healthcare teams, sales teams, and insurance companies
Collaborate cross-functionally with other Cardiology Health teams
Ensure coverage and payer requirements
Gather clinical documentation to support medical necessity for Cardiology devices
Process paper and electronic correspondence, including logging and distribution of payer and patient inquiries
Establish and maintain positive partnerships with sales team and healthcare teams
Review and assess clinical documentation to ensure all applicable coverage criteria requirements are met
Prepare and submit prior authorization initial and renewal requests to all insurance companies
Process authorization decisions from payers timely to streamline and drive revenue
Identify payer trends and establish payer-specific strategies to overcome reimbursement challenges
Provide superior customer experience by leveraging the ability to discuss payer policies, coverage criteria, or any pertinent product information with patients and healthcare teams
Understand and adhere to all policies for Baxter and 3rd party payers to ensure the highest standards of quality and compliance
Consistently contribute to team goals and understand how they support greater organizational goals
Actively seek additional experience and knowledge across all functional areas to gain expertise
Provide workload coverage as needed
Perform other duties and projects as assigned

Requirements

High school diploma or equivalent required
Associates degree or higher preferred
3+ years of industry experience in health insurance
Knowledge of Federal, State, and Local regulations, guidelines, and standards, including a working knowledge of HIPAA rules and regulations
Third party payer experience strongly preferred
Experience in reviewing medical records and obtaining third-party payer reimbursement
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

What we offer

Support for Parents
Continuing Education/ Professional Development
Employee Heath & Well-Being Benefits
Paid Time Off
2 Days a 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

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Medical Records and Authorization Specialist

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