The Payor Specialist enables the Village to give life by identifying and addressing payor behavior which could include programs like Prospective Payment System or Healthcare Exchange Programs. This teammate plays a key role in achieving overall performance goals and becoming a world class revenue partner through effective and timely collection activities while reducing bad debt. This position reports to the Supervisor, of Patient Accounts (ROPS) and /or the Manager, Patient Accounts (ROPS).
ESSENTIAL DUTIES & RESPONSIBILITIES
The following duties and responsibilities generally reflect the expectations of this position but are not intended to be all-inclusive.
1. Analyzes large volumes of data to support decisions that drive business results through monthly AR Reviews, Weekly performance reporting, and Ad-hoc analysis requests
2. Identifies adverse plan designs and payor behavior and partners with cross functional teams to resolve
3. Serves as inter-department resource and subject matter expert regarding payor related opportunities and
a. Partners with payor contracting in providing analytics to support decision making on contract status
b. Responds to requests from cross functional teams which may include: Mainstream, Diplomats, Project Managers, and Senior Leadership for updates on payor related issues
4. Communicates key takeaways from analysis to aid Senior Leadership in making strategic business decisions
5. Identifies payor trends and or root cause of billing or claim exceptions; resolve and/or escalate issues
6. Educates payors on accurate Prospective Payment System (PPS) through appeals and phone calls
7. Minimizes bad debt by ensuring timely follow-up of all programs like primary exchange and short-paid Medicare Advantage claims, resolution of denials, and other payor related correspondence
8. Identifies industry and payor changes impacting revenue cycles
9. Ability to work independently with minimal guidance, as well as strong time management skills and meeting strict deadlines
• Bachelor’s degree preferred
• One year prior experience in collections/Accounts Receivable strongly preferred
• Ability to work on several projects simultaneously
• Intermediate computer proficiency in Microsoft Office including Word, Excel, and Outlook
DaVita is an equal opportunity/affirmative action employer. As such, DaVita makes hiring decisions solely on the basis of qualifications and experience, and without regard to race, color, religion, sex, gender identity, sexual orientation, national origin, disability or protected veteran status.
We maintain a drug-free workplace and perform pre-employment substance abuse testing and background verification checks.