Medicare Audit/Appeal Specialist

This is where you save and sustain lives

At Baxter, we are deeply connected by our mission. No matter your role at Baxter, your work makes a positive impact on people around the world. You’ll feel a sense of purpose throughout the organization, as we know our work improves outcomes for millions of patients. 

Baxter’s products and therapies are found in almost every hospital worldwide, in clinics and in the home. For over 85 years, we have pioneered significant medical innovations that transform healthcare.

Together, we create a place where we are happy, successful and inspire each other. This is where you can do your best work. 

Join us at the intersection of saving and sustaining lives— where your purpose accelerates our mission. 

Your Role at Baxter

THIS IS WHERE you build trust to achieve results

As a Medicare Audit/Appeal Specialist for our Respiratory Health Division, you will be responsible for the timely completion of various Medicare Fee for Service Audits. All audit activity needs to be tracked for findings and resolutions with appropriate response to Medicare.  Identify trends and look for opportunities for process improvement.

In addition, the Medicare Audit/Appeal Specialist is responsible for providing advocacy support to patients who are denied coverage for any Baxter Respiratory Health products. This role requires creating persuasive appeal correspondence to Payers, while adhering to business process standards and/or review clinical documentation to meet Medicare coverage criteria.

The role communicates directly with patients, healthcare teams, and payer as well as collaborating cross-functionally with other Respiratory Health teams to coordinate in our Mission to Save and Sustain Lives.

What You’ll Be Doing:

• Prepare and submit pre- and post-payment Audits to Medicare programs.

• Maintain records of all audit activity.

• Collaborate with the Supervisor for appropriate response to audit findings.

• Communicate audit observations and findings to improve outcomes.

• Review and evaluate patient medical documentation independently to determine if records meet Medicare Coverage policy criteria for Respiratory Health Products for reimbursement. Also review medical history, interview patients, contact medical professionals as needed while ensuring claim integrity and compliance within payer and regulatory guidelines.

• Prepare and submit persuasive appeal request to Medicare (redetermination, Reconsiderations and Administrative Law Judge (ALJ)

• Provide superior customer experience in discussing payer policies, coverage criteria, benefit limitations, potential cost, and any pertinent product information with patients and healthcare teams.

• Prioritize workload based on clinical strength of cases and potential for payment.

• Maintain understanding of department policies and procedures.

• Work with internal departments and/or communicate directly with prescribing and/or primary care clinics as needed to gather clinical information necessary to support appeal.

• Identify appropriate resolutions for files if denials are upheld.

• Identify payer trends and establish payer-specific strategies.

• Initiate the pick-up process, when necessary

• Perform other duties and projects as assigned.

What You’ll Bring:

• Respiratory Therapist (RT), Licensed Practical Nurse (LPN), Registered Nurse (RN) or Paralegal required.

  • Current professional licensure or certification as required by the state of residence.

• 1+ years industry experience (3rd party payer or DME provider) preferred.

• Knowledge of Medicare Regulations preferred.

• Experience in reviewing medical records and obtaining third party reimbursement.

• Knowledge of federal, state, and local regulations, guidelines, and standards, including a working knowledge of HIPAA rules and regulations.

• Strong organizational, critical thinking and problem-solving skills.

• Customer service oriented.

• Proficiency in Microsoft Office Software.

• Experience with TIMS System preferred.

Baxter is committed to supporting the needs for flexibility in the workplace. We do so through our flexible workplace policy which includes a minimum of 3 days a week onsite. This policy provides the benefits of connecting and collaborating in-person in support of our Mission.

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 our employees, and we strive to be more transparent with our pay practices.  To that end, this position has a base salary range of $64,000 to $88,000 plus an annual incentive bonus. The above range represents the expected base salary range for this position.  The actual salary may vary based upon several factors including, but not limited to, relevant skills/experience, time in the role, business line, and geographic/office location.

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.

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Equal Employment Opportunity

Baxter is an equal opportunity employer. Baxter evaluates qualified applicants without regard to race, color, religion, gender, national origin, age, sexual orientation, gender identity or expression, protected veteran status, disability/handicap status or any other legally protected characteristic.

EEO is the Law 
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Pay Transparency Policy

Reasonable Accommodations

Baxter is committed to working with and providing reasonable accommodations to individuals with disabilities globally. If, because of a medical condition or disability, you need a reasonable accommodation for any part of the application or interview process, please click on the link here and let us know the nature of your request along with your contact information.

Recruitment Fraud Notice

Baxter has discovered incidents of employment scams, where fraudulent parties pose as Baxter employees, recruiters, or other agents, and engage with online job seekers in an attempt to steal personal and/or financial information. To learn how you can protect yourself, review our Recruitment Fraud Notice.