Summary

The ROPS Specialist II, Collections (Lab) is to secure maximum reimbursement on all claims based on payer terms. Applies the knowledge and skills to complete a wide range of tasks at a level which meets department standards and ensures goals and objectives are achieved. Ensures claim adjustments are applied using the appropriate payer terms and based on department guidelines. Adheres to DaVita policies including corporate compliance and all rules and regulations under the applicable local, state, and federal agencies and accrediting bodies. This position reports to the Supervisor, Patient Accounting (Lab).

Job description

General Purpose of the Job

The ROPS Specialist II, Collections (Lab) is to secure maximum reimbursement on all claims based on payer terms. Applies the knowledge and skills to complete a wide range of tasks at a level which meets department standards and ensures goals and objectives are achieved. Ensures claim adjustments are applied using the appropriate payer terms and based on department guidelines. Adheres to DaVita policies including corporate compliance and all rules and regulations under the applicable local, state, and federal agencies and accrediting bodies. This position reports to the Supervisor, Patient Accounting (Lab).

Essential Duties & Responsibilities

Initiates collection follow up of all denials with insurance payer to ensure proper reimbursement on claims.
Researches, appeals, resolves claim rejections and underpayments with the payer based on payer terms.
Responds to written payer communications with appropriate action in timely manner.
Processes claims, re-bills and appeals.
Requests medical documentation from facilities.
Types, scans (files in electronic claims library by payer) and mails appeal.
Documents daily in the A/R system all follow up and communication on a patient account in a consistent and concise format and escalates issues to lead and supervisor based on department standards.
Validates and requests insurance changes through the A/R system as required during collections process.
Retrieves assigned data and prioritizes based on AR department guidelines.

Education and Experience

2-4 years experience preferred.
Intermediate computer skills and proficiency in MS Word, Excel, Outlook, and an electronic accounts receivable system required.
Must have high school diploma.

Requirements

High school diploma required
Intermediate computer skills required
Proficiency in MS Word, Excel, Outlook required
Proficiency in an electronic accounts receivable system required
2-4 years experience preferred

Benefits

Medical, Dental & Vision
401(k) Match
Paid Time Off
PTO Cash Out
Family Resources
EAP Counseling
Headspace Access
Backup Child & Elder Care
Maternity & Paternity Leave
Professional Development Programs

Company overview

DaVita Kidney Care is a leading American healthcare provider specializing in kidney dialysis services, operating as one of the largest dialysis companies in the United States. Founded in 1992 and headquartered in Denver, Colorado, DaVita operates a vast network of 2,675 outpatient dialysis centers across the United States, serving approximately 200,800 patients, with an additional 367 centers in 11 other countries serving 49,400 patients. The company primarily treats end-stage renal disease (ESRD), providing life-sustaining dialysis treatments that patients typically require three times per week. DaVita holds approximately 37% market share in the U.S. dialysis market and is publicly traded on the New York Stock Exchange under the ticker DVA. The company's name, derived from the Italian phrase "Dare Vita" meaning "to give life," reflects its mission to provide essential kidney care services. With approximately 76,000 employees, DaVita has established itself as a Fortune 500 company and a significant player in the healthcare industry, with Berkshire Hathaway owning a 41.2% stake in the organization.