Reimbursement Specialist

• Perform verification of eligibility and benefits to determine coverage and payer requirements
• Ensure all benefit information is loaded correctly to reduce rework and allow for clean claims
• Gather clinical documentation to support medical necessity for Cardiology products and assess clinical documentation to ensure all applicable prescription, face to face, and coverage criteria requirements are met
• Prepare and submit prior authorization requests to insurance companies including commercial payers as well as government payers including Medicare and Medicaid
• Process authorization decisions from payers timely to streamline and drive revenue
• Negotiate payment rates for letter of agreement to ensure maximum collection potential
• Provide a superior customer experience by leveraging ability to discuss payer policies, coverage criteria, benefit limitations, potential cost, 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

• 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

• 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