Medicare Clinical 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. 

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

The Medicare Clinical Specialist is responsible for reviewing patient medical records to determine if they are eligible and meet Medicare Fee for Service coverage criteria. The Medicare Clinical Specialist evaluates medical documentation using independent judgement and discretion to ensure Medicare rule and regulations are followed that maintain company compliance with laws and regulatory requirements for Baxter's Respiratory Health products. The role communicates directly with patients, healthcare teams, and Account Executive (sales) 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:

• 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.
• Collaborate cross-functionally to identify and recommend appropriate process or procedure changes to support improved strategy for third party reimbursement.
• Provide superior customer experience in discussing payer policies, coverage criteria, benefit limitations, potential cost, and any pertinent product information with patients and healthcare teams.
• Actively seek additional experience and knowledge across all functional areas to gain expertise including ongoing Medicare and third-party reimbursement education.
• Identify and execute appropriate resolution for files if denied by Payer.
• 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), or Registered Nurse (RN),  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.

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 
EEO is the law - Poster Supplement
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.