Spec, File Resolution

Spec, File Resolution

Join to apply for the Spec, File Resolution role at Baxter International Inc.

This is where your work makes a difference.

At Baxter, we believe every person—regardless of who they are or where they are from—deserves a chance to live a healthy life. It was our founding belief in 1931 and continues to be our guiding principle. We are redefining healthcare delivery to make a greater impact today, tomorrow, and beyond.

Our Baxter colleagues are united by our Mission to Save and Sustain Lives. Together, our community is driven by a culture of courage, trust, and collaboration. Every individual is empowered to take ownership and make a meaningful impact. We strive for efficient and effective operations, and we hold each other accountable for delivering exceptional results.

Here, you will find more than just a job—you will find purpose and pride.

Your role at Baxter

The File Resolution Specialist is responsible for providing direct support to the Revenue Cycle Management Department, which includes Reimbursement Services, Medicare, Billing and Collections Teams. This position requires use of data analysis tools and reporting, along with comprehensive understanding of the revenue cycle, to analyze and resolve patient files that did not follow the standard reimbursement process. Additionally, this position will work with the management team to identify process and procedure gaps, to ensure maximum reimbursement potential.

• Develop a plan and/or strategy to get patient accounts back into the reimbursement process flow, either through obtaining prior authorization, performing change of insurance, and/or obtaining payment on claims.
• Complete complex research on patient accounts from intake through billing and collections to identify the gaps preventing reimbursement and provide a summary for resolution.
• Utilize various investigational tools such as Lexus Nexus, or Google to locate patient contact info, including use of classified and confidential database.
• Identify trends and opportunities for improvement in various processes, to increase profitability and cash flow, along with recommended solutions to the RCM Management Team.
• Identify files that need reactivation when escalated payer issues are resolved, and triage files to the appropriate departments, and provide direction regarding actions to take for reimbursement.
• Maintain a standard review and audit process for all files entering a suspended/inactive status to ensure appropriate steps have been taken before exhausting reimbursement efforts.
• Analyze and work various revenue reports, including, but not limited to “claim validation”, “return billing report”, to ensure all reimbursement procedures were followed, and claims can be released to payers or funneled back into the reimbursement process or accounts are closed out in the appropriate manner.
• Contact patients/families/caregivers as needed to obtain current demographics, insurance, physician, and device usage, to ensure appropriate insurance reimbursement.
• Obtain appropriate documentation such as medical records, Medicare Advanced Beneficiary Notice (ABN), Terms Conditions Responsibility Form (TCR), and Patient Waiver Form as needed for reimbursement.
• Participate in various continuous improvement projects as assigned.

• Associate’s degree or higher preferred
• 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

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 employees, and we strive to be more transparent with our pay practices. The estimated base salary for this position is $60,000.00…