Spec, Reimbursement

About the role

In this role you will perform Reimbursement Specialist duties for assigned territory or payer(s) including eligibility and benefit verification, documentation collection, prior authorization and reauthorization submissions, letter of agreement payment negotiations, and processing payer decisions. As the Reimbursement Specialist you will communicate directly with patients, healthcare teams, and insurance companies as well as collaborating cross-functionally with teams to coordinate in our mission of enhancing outcomes for patients and their caregivers.

This is a full-time hybrid position where the candidate would report to the St. Paul office three days a week, Monday through Friday. The hours of operation are 8:00am - 4:30pm CST.

Responsibilities

• 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.

Requirements

• 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 oriented 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.

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.

Pay

The estimated base salary for this position is $49,600 to $68,200 annually. The estimated range is meant to reflect an anticipated salary range for the position. We may pay more or less than of the anticipated range based upon market data and other factors, all of which are subject to change. Individual pay is based on upon location, skills and expertise, experience, and other relevant factors.

Benefits

• Medical and dental coverage starting 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) with the ability to purchase company stock at a discount.
• 401(k) Retirement Savings Plan (RSP) with options for employee contributions and company matching.
• 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, and paid parental leave.
• Commuting benefits.
• Employee Discount Program.
• Employee Assistance Program (EAP).
• Childcare benefits.