DaVita Payor Specialist in Irvine, California

The purpose of this position is to identify and maintain in DaVita's systems, Medicare, Medicaid, Government Program, Commercial, and Contracted payor requirements, specifically related, but not limited to claim formatting, billing, and claim submission guidelines.

ESSENTIAL DUTIES AND RESPONSIBILITIES :

  • Track and follow up on all Medicare, Medicaid, Government Programs, Commercial and Contracted Payor issues through the Remedy system with a concentration on root cause analysis and resolution
  • Follow up with payor representatives and communicate issues and their resolution to customers within Revenue Operations and other impacted departments
  • Monitor workflow system to ensure Payor issues are addressed daily and followed up on time
  • Identify updates and/or changes to payor requirements prior to implementation and work with applicable Revenue Operations teams to ensure those changes are accurately reflected in all legacy systems
  • Work directly with payor representatives, and/or third party clearinghouse, or teammates to resolve reported payor issues
  • Serve as liaison between the Payor Contracting and ROPS Payor Specialist Team on all payor issues related, but not limited to claim formatting, rates, and all applicable payor requirements
  • Communicate issues pertaining to all payor issues, the root causes, and resolutions to upper management
  • Identify and communicate payor and claim level requirements to impacted areas within Revenue Operations department
  • Ensure that payor and claim level issues are corrected in legacy billing system when applicable
  • Other duties and responsibilities as assigned including but not limited to:

  • Work overtime with little or no notice as needed

  • Consistent, regular, punctual attendance as scheduled is an essential responsibility of this position

MINIMUM QUALIFICATIONS

  • High School diploma or equivalent
  • Basic computer skills and proficiency in MS Word, Excel, PowerPoint, and Outlook required
  • Intermediate skills in electronic billing systems preferred
  • Experience with healthcare reimbursement issues, especially as related to commercial and government payors and the electronic submission of claims

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, co-workers, management, physicians, and/or vendors in every day performance and interactions
  • Demonstrated strengths in organization, attention-to-detail, follow-through, analytical, reasoning, critical thinking, and problem solving skills
  • Excellent written, verbal, and interpersonal communication skills with an acute ability to listen attentively and to communicate effectively throughout all levels of the organization
  • Demonstrated commitment to customer service; proactively communicate and respond promptly to teammate needs
  • Self-directed; able to work independently and as a member of a team and to foster a positive work environment

LANGUAGE SKILLS

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

Vision requirements

Vision adequate to perform the essential duties and responsibilities of position including repetitive use of computer monitor.

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 1 pounds to a maximum of 10 pounds unassisted, and able to perform repetitive standing, sitting, stooping, walking, stretching, reaching, and use full range of body motions.
  • Ability to use computer keyboard and peripherals to accomplish required tasks in a timely manner is a core requirement of this position.

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.

Why wait? Explore a career with DaVita today.

Go to http://careers.davita.com/ to learn more or apply.

Here is what you can expect when you join our Village.

  • Fun, relationships-based culture-patient- and teammate-driven
  • FORTUNE 500 stability-with the nation's largest independent provider of dialysis services
  • Training Magazine Top 125 award-winning education
  • Multiple career paths across a variety of cutting-edge modalities
  • Rewards for your stellar performance
  • Clinical outcomes consistently ranked above the national average-treating more than one-third of the dialysis population (that's approximately 100,000 patients!)
  • Exceptional benefits-including the healthcare industry's most generous profit sharing program
  • Dedication above all to caring for patients suffering from chronic kidney failure-at over 800 hospital units and approximately 1,500 outpatient dialysis clinics nationwide

To learn more about DaVita and the world of dialysis, click here .

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DaVita is proud to be an EEO/AA employer M/F/D/V.

We maintain a drug-free workplace and perform pre-employment substance abuse testing and background verification checks.