Revenue Lead, ROPS

GENERAL PURPOSE OF THE JOB

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

SUPERVISORY RESPONSIBILITIES: No

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 billing or claim exceptions; take appropriate steps to resolve and/or escalate issues to minimize bad debt

• 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 teammate's questions and assist with issues of focus and problematic payer issues

• Train new teammates

• Identify training opportunities to improve individual and team performance; perform one-on-one and group training as needed

• Recommend changes on collection teams, tools, policies and procedures

• Perform all close reconciliation approvals and related activities to ensure timely submission of primary, secondary and tertiary insurance claims. Serve as a subject matter expert for close

• Review and approve adjustments and claims appeals submitted by Specialist of Patient Accounts

• Conduct quality assurance reviews of work output and provide feedback to teammates 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 changes to ESRD and Medicare Secondary Provider laws and changes

• 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, teammate, and company information in accordance with HIPPA regulations and DaVita policies

• Know, understand, and follow DaVita teammate 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

• 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 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, teammates, management, physicians, and/or vendors (Village Service Partners) in everyday performance and interactions

Core Competencies required of this position:

Building Relationships / Collaboration

Definition: Use appropriate interpersonal skills to foster positive relationships through the village and with external customers in a way that promotes openness and trust and gives them confidence in one's intentions.

Key Actions:

• Establishes relationships: connects easily with people and acts as a collaborative partner: puts others at ease and gains personal acceptance.

• Seeks opportunities: Proactively tries to build effective working relationships with other people.

• Demonstrates emotional intelligence: Uses strong conflict resolution skills.

• Demonstrates openness in dealing with others: Acts in a manner consistent with the village and team mission and values; ensures that words and actions are consistent; keeps commitments to agree upon action.

• Provides service excellence: Be a trusted partner to all peers, customers, support teams and leaders in an effort to build solid relationships.

Communication / Influence

Definition: Possess the ability to clearly and concisely communicate to internal and external customers; Influences and gains commitment from key stakeholders to take action that will advance shared interests and business goals.

Key Actions:

• Clarifies purpose and importance when communicating with others: Actively listens and responds appropriately.

• Seeks to understand: Uses open-ended questions to explore issues and clarify perspectives and goals.

• Makes a compelling case: Presents logical and rationale recommendations in a manner that clearly links them to critical business priorities.

• Gains Commitment: Adjusts influence strategy based on stakeholder perspectives; leverages shared goals to convince others to take action; handles objections; asks for agreement to next steps.

• Effectively Communicates: Listens without passing judgment and doesn't rush in to give advice; communicates with respect in every interaction.

Adaptability

Definition: Maintains effectiveness when experiencing various changes in work responsibilities or environment; learns and adjusts effectively to work within new work systems, processes, requirements, and act.

• Key Actions:

• Demonstrates an understanding of changes: Actively seeks information about new work situations; strives to understand the rationale and implications for changes in works responsibilities or environment.

• Embraces change openly & positively: Treats change and new situations as opportunities for learning and growth; identifies the benefits of change; speaks positively about the change to others.

• Quickly gains knowledge, understanding or skill: Demonstrate the ability to integrate new information and draws conclusions from it.

• Adjusts behavior: Quickly modifies behavior to deal effectively with changes in the work environment; tries new approaches appropriate for new or changed situations; does not persist with ineffective behaviors.

• Believes continuous improvement is a way of life: Processes the change unselfishly & seeks to understand the overall village impact.

Managing Work (Includes Time Management)

Definition: Effectively organize and manage time and resources to ensure that work is completed efficiently; takes timely and appropriate action to accomplish a task and / or resolve the issue.

• Key Actions:

• Effectively manage multiple assignments and priorities: Identifies critical activities and tasks and arranges them in order of relevance; adjusts priorities when appropriate.

• Makes preparations: Ensures that required materials are in appropriate location and ensure work is completed timely and effectively.

• Schedules: Effectively allocates own time to complete work; coordinates schedule to avoid conflicts.

• Utilizes resources: Demonstrates ability to delegate and takes advantage of available resources (individuals, processes, departments and tools) to complete work efficiently.

• Stays focused: Uses time effectively and prevents irrelevant issues or distractions from interfering with work completion.

Critical Thinking

Definition: Identifies and seeks to understand issues, problems, and opportunities; compares information from different sources to draw conclusions; uses effective approaches for choosing a course of action or developing appropriate solutions.

• Key Actions:

• Recognizes issues, problems or opportunities: determines the necessary action that is needed.

• Asking clarifying questions: in order to identify and better understand issues, problems and opportunities.

• Integrates information from a variety of sources; identify trends and cause - effect relationships within and outside of their lane.

• Develop and or evaluate relevant options: for addressing trends / opportunities to achieve desired resolution.

• Utilize firm decision making and reasoning skills: to ensure understanding of the end result.

• Formulate recommended action: and include others in the decision making process when warranted.

Action Oriented

Definition: Takes prompt and appropriate action to accomplish objectives; takes action to achieve goals beyond what is required; is proactive.

• Key Actions:

• Responds timely: Takes immediate action when confronted with a problem or when made aware of a situation.

• Takes independent action: Initiates and implements new ideas or potential solutions without prompting; does not wait for others to take action or to request action.

• Goes above and beyond: Takes action that goes beyond job requirements in order to achieve objectives.

• Ability to initiate new ideas: Turns ideas into processes with proven results.

• Ability to follow Compliance protocol: Have a firm understand to ensure appropriate procedures and guidelines are followed and applied as appropriate.

LANGUAGE SKILLS

Fluent in the written and verbal skills necessary to successfully perform the essential functions, duties, and responsibilities of the position.

• Ability to understand clinical/medical vocabulary written or spoken in English required.

VISUAL REQUIREMENTS:

Vision adequate to perform the essential duties and responsibilities of position.

PHYSICAL DEMANDS

Physical requirements can vary. These must be reviewed with management. However, in general, the position requires the following physical activities:

• Ability to lift minimum of 2 pounds to a maximum of 15 pounds unassisted; able to sit for extended periods of time with some standing, stooping, walking, stretching, reaching, lifting; moderate range of body motions

• Ability to hear and interact by phone, in person, and in presentations clearly and efficiently

• Ability to use computer and all peripherals as needed to meet goals

WORK ENVIRONMENT

Level III - Moderate noise (examples: business office with computers and printers, light traffic)

No required tasks involve greater exposure to blood, body fluids or tissues than would be encountered by a visitor. The normal work routine involves no exposure to blood, body fluids or other hazardous conditions.