Spec, Insurance Discovery

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:The Spec, Insurance Discovery provides direct support to the Revenue Cycle Management Department, which includes Reimbursement Services, Cash Application, Patient Account Specialist, Billing and Collections. This position is required to collaborate cross-functionally with other Cardiology healthcare teams to coordinate and align in our mission statement of Saving and Sustaining Lives. The Spec, Insurance Discovery position requires use of data analysis tools and reporting, along with comprehensive understanding of the revenue cycle process, 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.What you'll be doing: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 that fall into our “Error processing” process, to identify the gaps preventing reimbursement and provide a summary for resolution.Utilize various investigational tools to locate patient contact info, including use of classified and confidential databases.Ensure the accuracy of patient demographics and benefit information on file to reduce claim submission errors.Ensure claims are processed promptly, while identifying and resolving claims issues resulting in delayed processing and adjudication.Identify payer trends and establish payer-specific strategies to overcome reimbursement challenges.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/Clients and Account Executives as needed to obtain current demographics, insurance, physician, and device usage, to ensure appropriate insurance reimbursement.Ensure timely follow-up and follow-through...