Revenue Specialist III- Credits (ROPS)

Posting Date

Remote Position

Position Summary

The Revenue Specialist Bulk Payor Analytics (BPA) plays a critical role in protecting enterprise revenue by identifying influencing and resolving systemic payor-driven credit issues at scale. Unlike traditional claims-based roles this position operates upstream analyzing payor behavior negotiating resolution strategies and partnering across Revenue Operations (ROPS) Payor Partnerships Legal and Compliance to eliminate credit inflow at the source.

The Revenue Specialist BPA is a specialized role within Team Sonar. Unlike traditional ROPS roles that focus on working claims one-by-one the Bulk Payor Analytics (BPA) team is dedicated to early and ongoing identification of overpayment trends performing root cause analysis comprising and escalating issues to the payor or internal ROPS support teams and resolving payment misalignments in bulk.

In this role you will analyze high-volume payor trends identify upstream issues causing credit inflow (such as rate discrepancies contract misalignments or rounding errors) and partner with cross-functional teams (Manestream Collections Team Spotlight Team Lighthouse Registration Government Payor Alliance (GPA) Payor Partnerships and others) to turn off the faucet of incoming credits. You will move beyond transactional work to strategic problem-solving helping to protect revenue and improve operational efficiency for the Village.

Essential Duties & Responsibilities

Root Cause Analysis & Trend Identification:

• Deep-dive into high-volume payor data to identify credit balance trends and differentiate credits from overpayments

• Analyze payor reimbursement behavior against contracts to identify discrepancies (e.g. rate errors non-covered services rounding issues)

• Investigate the why behind credit inflow to determine if issues are systemic or isolated

Payor & Stakeholder Negotiation:

• Serve as primary ROPS representative in discussions with payor partners to negotiate resolution paths for systemic overpayment and reimbursement issues.

• Present data-backed findings to payors analysts and internal stakeholders to drive agreement on corrective action timelines

• Influence outcomes through clear articulation of root cause financial impact and operational feasibility often without direct authority

Collaboration & Process Improvement:

• Partner closely with internal teams including Payor Partnerships Spotlight Manestream Collections Legal Compliance Registration and Admissions to address upstream drivers of credit inflow

• Escalate systemic contract configuration or process issues with clear documentation financial impact analysis and recommended solutions

• Translate analytical findings into actionable change ensuring fixes are implemented not just identified

• Present issues on calls/meetings with key stakeholders

• Develop and manage key relationships with external partners. Develop timelines and execute the action items necessary to resolve escalations

• Effective and professional communication (written and verbal) with key stakeholders

Bulk Resolution & Project Work/Management

• Formulate and execute bulk resolution strategies to resolve large populations of claims at once (e.g. Bulk Processing Unit (BPU) files bulk retractions and bulk disputes) rather than processing claims individually

• Manage multiple projects for targeted payors/financial classes (e.g. Medicare Advantage Managed Medicaid etc) to clear historical credit backlogs and prevent future inflow

• Review and audit BPU files with high attention to detail to ensure accuracy before processing

Reporting & Technical Operations

• Utilize Tableau Excel and internal billing systems (Nautilus) to monitor inventory and track resolution progress

• Maintain accurate documentation of identified trends and resolution plans

• Manage payor portfolio and inventory effectively meeting commitments for both BPA specific requirements as well as for upstream/external parties

Qualifications

Required: High school diploma or equivalent

• Strong critical thinking and problem-solving skills: Ability to look at a situation identify patterns and determine the best course of action. Creative thinker who embraces trying new approaches and learn from other perspectives

• Intermediate Excel skills: Ability to work with data sets filter sort and perform basic analysis

• Attention to detail: Crucial for auditing bulk files where a single error can affect hundreds of claims. Strong written and verbal communication skills for interacting with payors and internal teams

• Adaptable and agile Able to operate in a fast-paced environment where day to day priorities can shift. Comfortable with navigating change and able to approach large change management events with positive focus

• Ability to synthesize complex data into clear narratives for senior leaders and external partners

• Navigate ambiguity and drive alignment across multiple stakeholders with competing priorities

• Demonstrate experience influencing outcomes without direct authority

• Time Management: Understands how to effectively manage their time and prioritize the correct work meet deadlines and self-correct when needed

• Accountability: Holds themselves to high-quality standard of work and exudes a continuous-improvement mindset at all times. Self-starter with workload

• Knowledge of insurance rules and regulations (Medicare Advantage Medicaid Commercial etc)

• Experience with DaVita revenue cycle systems (Nautilus CAT Reggie etc.)

• Experience reading and interpreting payor contracts and explanation of benefits (EOBs)

What You Can Expect

A Community First Company Second Culture: We are a team that supports one another. You will join a village where we care for our patients and each other

Autonomy & Impact: You will own a specific book of business or project scope giving you the opportunity to drive real results that impact the bottom line

Growth Opportunities: This role offers deep exposure to the analytical side of Revenue Operations paving the way for future growth into analyst or leadership roles

What Well Provide:

More than just pay our DaVita Rewards package connects teammates to what matters most. Teammates are eligible to begin receiving benefits on the first day of the month following or coinciding with one month of continuous employment. Below are some of our benefit offerings.

• Comprehensive benefits: Medical dental vision 401(k) match paid time off PTO cash out

• Support for you and your family: Family resources EAP counseling sessions access Headspace backup child and elder care maternity/paternity leave and more

• Professional development programs: 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 DaVitas online training platform StarLearning.

#LI-RH1

At DaVita we strive to be a community first and a company second. We want all teammates to experience DaVita as a place where I belong. Our goal is to embed belonging into everything we do in our Village so that it becomes part of who we are. We are proud to be an equal opportunity workplace and comply with state and federal affirmative action requirements. Individuals are recruited hired assigned and promoted without regard to race national origin religion age color sex sexual orientation gender identity disability protected veteran status or any other protected characteristic.

This position will be open for a minimum of three days.

Required Experience:

IC