State Licensed Clinical Appeals Advocate

Job Summary

Serving as a key patient advocate, the full-time remote State Licensed Clinical Appeals Advocate will manage insurance denials for Baxter's Respiratory Health products by collaborating with patients, healthcare teams, and payers to secure access to necessary therapies.

Key responsibilities

• Assess cases and develop appeal strategies, preparing persuasive submissions for payers
• Communicate with patients regarding appeal strategies and support them during the process
• Build and maintain relationships with case managers and medical directors to enhance patient outcomes

Required qualifications

• Registered Nurse (RN), Respiratory Therapist (RT), or Licensed Practical Nurse (LPN) with active state licensure or certification
• Associate degree or higher, or equivalent work experience in a related clinical or reimbursement field
• Minimum of 3 years of experience in reviewing medical records and securing third-party reimbursement
• Knowledge of federal, state, and local regulations, including HIPAA and payer guidelines
• Proficiency in Microsoft Office and related software tools