Revenue Lead, ROPS

Insurance Coverage Specialist

This position researches and resolves high complexity insurance coverage discrepancies according to DaVita policies and procedures and compliance with federal and state billing regulations. This position also provides ongoing training and guidance for Revenue Specialist teammates, and performs data trending analysis, quality assurance reviews and review of key metrics.

Essential Duties And Responsibilities:

The following duties and responsibilities generally reflect the expectations of this position but are not intended to be all-inclusive.

• Review, weekly and monthly key metrics to identify trends or areas of focus; work with management to develop, document, and implement action plans to address issues
• Identify payer trends and or root cause of denials or spikes in verification requests; take appropriate steps to resolve and/or escalate issues to ensure accuracy and reduce need for re-verifications
• Identify and interpret policies related to exceptions
• Determine and apply appropriate business action in absence of policies or in cases of ambiguity
• Escalate issues as needed; provide recommendations
• Act as resource for team member's questions and assist with issues of focus and problematic payer issues
• Onboard and coach new team members
• Identify training opportunities to improve individual and team performance; perform one-on-one and group training as needed
• Recommend changes on registration teams, tools, policies and procedures
• Perform all close reconciliation approvals and related activities to ensure timely coverage change reviews. Serve as a subject matter expert for close
• Conduct quality assurance reviews of work output and provide feedback to team members and management; offer suggestions for improvement
• Ability to manage and lead multiple projects, meet deadlines, and adjust priorities appropriately in a high paced work environment. Support department initiatives.
• Stay abreast of policy updates that impact coverage setting for regulatory and commercial payors
• Strong analytical skills, follow through; with the ability to seek underlying assumptions through probing, questioning, listening, and problem solving
• Ability to interact positively with all levels of the company
• Maintain confidentiality of all patient, team member, and company information in accordance with HIPPA regulations and DaVita policies
• Know, understand, and follow DaVita team member handbook, employment policies, safety and security policy and procedures

Other duties and responsibilities as assigned including but not limited to:

• Consistent, regular and punctual attendance as scheduled
• Overtime may be required to ensure timely completion of tasks and required duties
• Attend team meetings, phone conferences, and training as needed
• Host or co-host team meetings
• Collaborate with supervisor on team-building
• Know, understand, and follow department or company procedures
• Embrace the DaVita culture by actively participating in village and neighborhood initiatives
• Demonstrate DaVita's core values in all aspects of your role
• Less than 5% travel required

Minimum Qualifications:

Education, licenses, certifications, and experience required to fulfill the essential duties, include computer skills as required.

• High School diploma or equivalent required
• Two to four years' experience in healthcare reimbursement and revenue cycle management
• Experience leading a team or project preferred
• Intermediate proficiency in MS Excel, Word and PowerPoint

Essential Behaviors, Skills And Attitudes Required For Success In This Position:

Commitment to DaVita's values of Service Excellence, Integrity, Team, Continuous Improvement, Accountability, Fulfillment and Fun with ability to demonstrate those positively and proactively to patients, team members, management, physicians, and/or vendors (Village Service Partners) in everyday performance and interactions