ROPS Specialist I (Lab)

DaVita Kidney Care

About The Position

The ROPS Specialist I (Lab) performs essential duties within various teams of Revenue Operations. This role will apply knowledge and skills to complete a wide range of tasks at a level which meets department standards and ensures goals and objectives of Revenue Operations are achieved. Teammates will perform routine tasks with some variation from standard processes and are expected to address straightforward issues with moderate supervision. Building rapport with teammates, customers, fostering positive working relationships and contributing to a sense of belonging for all is expected. Learns to manage own time effectively, balancing all demands for assigned workstream, sets and manages deadlines and monitors work results to deliver on commitments. Works to develop and improve skills and knowledge. Generates creative solutions, collaborating with others where needed to explore alternative approaches. Identifying conflicts or roadblocks on assigned work, escalates concerns, support and collaborate with others to resolve issues is imperative. Actively seeks out new insights in functional area and communicates findings. Communicates by leveraging communication tools appropriately for team and business needs, adapting tone and language for audience. This position reports to the Supervisor Revenue Operations (Lab).

Requirements

0-2 years experience
Must have High School Diploma/GED
Must be fluent in the written and verbal skills necessary to successfully perform the essential functions, duties, and responsibilities of the position.
Able to work overtime as needed with little to no notice

Nice To Haves

Minimum of 6 months medical office or data entry experience preferred.
Strong 10 key skills by touch preferred.
Minimum of 50 wpm typing speed
Knowledge of medical terminology and how to read and locate information on insurance remittance advice or invoices preferred

Responsibilities

Generates and submits claims for electronic payers by utilizing the A/R system and clearinghouse to ensure proper and timely submission of all claim files
Resolves errors associated with claim submission rejections via the appropriate payer by researching and/or calling the payer and facilitating corrections by another department if necessary
Maintains payer billing and clinic demographic system tables timely and accurately
Tracks medical record requests, perform periodic billing audits
Maintains insurance records including but not limited to the patient’s eligibility and the calculation of coordination of benefits related to outpatient kidney dialysis lab testing. Teammates will utilize the patient insurance information provided by DKC ROPS, the facilities, and ancillary means to complete the registration process
Resolves multiple discrepancies/errors in the A/R system to ensure timely claim submission
Applies payments and/or denials to the appropriate patient claim accurately based on supporting documentation. Interprets non-cash denial line items accurately by selecting the closest related denial code in the AR system. When all efforts are exhausted, post unidentified items to unapplied cash and continues to seek resolution and perform adjustments within established department timeframes.
Balances all posted amounts to check and batch amount; troubleshoot as necessary; resolve any out-of-balance conditions by posting adjustments and corrections for reconciliation purposes.
Researches difficult Remittance Advices for resolution to avoid posting to the unapplied cash account by communicating with the insurance company and collections team for resolution assistance.
Update cash batch tracking, prioritize workload, resolves work queues, and adjusts misapplied payments timely
Takes appropriate steps to resolve credit balances, including but not limited to preparing the necessary documentation for processing a refund check from the Accounts Payable Department (Lab), requesting a recoupment from the payer, or completing an adjustment for false credits
Evaluate credit balances in the A/R system to determine whether or not a refund is due, or an adjustment is needed
Document pertinent information for the refund on the reversal tracking spreadsheet and address all returned checks and reprocess where applicable
Other duties and responsibilities as assigned

Benefits

Medical, dental, vision
401(k) match
paid time off
PTO cash out
Family resources
EAP counseling sessions
access Headspace®
backup child and elder care
maternity/paternity leave and more
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.