Revenue Specialist III, ROPS

DaVita Kidney Care

17h•Onsite

About The Position

The Revenue Specialist, Bulk Payor Analytics (BPA) plays a critical role in protecting enterprise revenue by identifying, influencing, and resolving systemic payor-driven credit issues at scale. Unlike traditional claims-based roles, this position operates upstream, analyzing payor behavior, negotiating resolution strategies, and partnering across Revenue Operations (ROPS), Payor Partnerships, Legal, and Compliance to eliminate credit inflow at the source. The Revenue Specialist – BPA is a specialized role within Team Sonar. Unlike traditional ROPS roles that focus on working claims one-by-one, the Bulk Payor Analytics (BPA) team is dedicated to early and ongoing identification of overpayment trends, performing root cause analysis, comprising and escalating issues to the payor or internal ROPS support teams and resolving payment misalignments in bulk. In this role, you will analyze high-volume payor trends, identify upstream issues causing credit inflow (such as rate discrepancies, contract misalignments, or rounding errors), and partner with cross-functional teams (Manestream Collections, Team Spotlight, Team Lighthouse, Registration, Government Payor Alliance (GPA), Payor Partnerships, and others) to “turn off the faucet” of incoming credits. You will move beyond transactional work to strategic problem-solving, helping to protect revenue and improve operational efficiency for the Village.

Requirements

High school diploma or equivalent
Strong critical thinking and problem-solving skills: Ability to look at a situation, identify patterns, and determine the best course of action.
Creative thinker who embraces trying new approaches and learn from other perspectives
Intermediate Excel skills: Ability to work with data sets, filter, sort, and perform basic analysis
Attention to detail: Crucial for auditing bulk files where a single error can affect hundreds of claims.
Strong written and verbal communication skills for interacting with payors and internal teams
Adaptable and agile – Able to operate in a fast-paced environment where day to day priorities can shift.
Comfortable with navigating change and able to approach large change management events with positive focus
Ability to synthesize complex data into clear narratives for senior leaders and external partners
Navigate ambiguity and drive alignment across multiple stakeholders with competing priorities
Demonstrate experience influencing outcomes without direct authority
Time Management: Understands how to effectively manage their time and prioritize the correct work, meet deadlines, and self-correct when needed
Accountability: Holds themselves to high-quality standard of work and exudes a continuous-improvement mindset at all times.
Self-starter with workload
Knowledge of insurance rules and regulations (Medicare Advantage, Medicaid, Commercial, etc)
Experience with DaVita revenue cycle systems (Nautilus, CAT, Reggie, etc.)
Experience reading and interpreting payor contracts and explanation of benefits (EOBs)

Responsibilities

Deep-dive into high-volume payor data to identify credit balance trends and differentiate credits from overpayments
Analyze payor reimbursement behavior against contracts to identify discrepancies (e.g., rate errors, non-covered services, rounding issues)
Investigate the “why” behind credit inflow to determine if issues are systemic or isolated
Serve as primary ROPS representative in discussions with payor partners to negotiate resolution paths for systemic overpayment and reimbursement issues.
Present data-backed findings to payors, analysts, and internal stakeholders to drive agreement on corrective action timelines
Influence outcomes through clear articulation of root cause, financial impact, and operational feasibility, often without direct authority
Partner closely with internal teams including Payor Partnerships, Spotlight, Manestream Collections, Legal, Compliance, Registration, and Admissions to address upstream drivers of credit inflow
Escalate systemic contract, configuration, or process issues with clear documentation, financial impact analysis, and recommended solutions
Translate analytical findings into actionable change, ensuring fixes are implemented, not just identified
Present issues on calls/meetings with key stakeholders
Develop and manage key relationships with external partners.
Develop timelines and execute the action items necessary to resolve escalations
Effective and professional communication (written and verbal) with key stakeholders
Formulate and execute “bulk” resolution strategies to resolve large populations of claims at once (e.g., Bulk Processing Unit (BPU) files, bulk retractions, and bulk disputes) rather than processing claims individually
Manage multiple projects for targeted payors/financial classes (e.g., Medicare Advantage, Managed Medicaid, etc) to clear historical credit backlogs and prevent future inflow
Review and audit BPU files with high attention to detail to ensure accuracy before processing
Utilize Tableau, Excel, and internal billing systems (Nautilus) to monitor inventory and track resolution progress
Maintain accurate documentation of identified trends and resolution plans
Manage payor portfolio and inventory effectively meeting commitments for both BPA specific requirements as well as for upstream/external parties

Benefits

Comprehensive benefits: Medical, dental, vision, 401(k) match, paid time off, PTO cash out
Support for you and your family: Family resources, EAP counseling sessions, access Headspace®, backup child and elder care, maternity/paternity leave and more
Professional development programs: DaVita offers a variety of programs to help strong performers grow within their career and also offers on-demand virtual leadership and development courses through DaVita’s online training platform StarLearning.

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