Revenue Specialist II (ROPS)

If you are currently working in the following ROPS Teams: Collections, Credits, or Registration, we would love to connect with you about this opportunity

This position performs critical revenue cycle duties focused on the evaluation, verification, and resolution of coverage changes. Working autonomously as part of Registration’s Coverage Comparison Queue (CCQ) team, the Revenue Specialist ensures the accuracy of patient insurance affiliations, manages retro coverage logic, and mitigates downstream revenue impacts such as inappropriate retractions or refunds.

Essential Duties & Responsibilities

• Coverage Evaluation & CCA Management: Monitor the Coverage Change Alerts (CCA) dashboard and review requested coverage changes. Validate entity and plan affiliations using multiple data points to ensure accurate processing and coordinate benefits (COB).
• Payment Integrity & Retain Decisions: Review paid claims to mitigate the risk of inappropriate retractions. Utilize systems (Nautilus, Registration System, Sparc, VIA) to evaluate and make standard “Retain” decisions that protect receipts and resolve discrepancies.
• Documentation & Compliance: Autonomously manage coverage approvals and denials with clear, standardized documentation in Registration System/NS notes. Maintain accurate patient accounts and strict confidentiality in accordance with HIPAA guidelines.
• Collaboration & Continuous Improvement: Partner across teams (Clinical, IMT, Collections, Admissions) to resolve patient coverage limitations and utilize root-cause analysis to identify workflow improvements.
• Other duties as assigned; including but not limited to:
  • Attend and facilitate team meetings, phone conferences, and training as needed.
  • Know, understand, and follow teammate guidelines, employment policies, and department or company procedures including SOX documentation and practices.

Experience and Required Skills

• Critical Thinking: Excellent critical thinking and problem-solving skills to navigate unique challenges in patient accounts and complex payor rules.
• Analytical Capability: The ability to think through complex situations (e.g., determining Retain vs. Resolve strategies based on Retro Coverage rules) and carefully identify the best action to take.
• Communication: Strong communication and interpersonal skills. The position involves precise documentation in internal systems and relationship building with other teammates and departments.
• Adaptability: Ability to adapt quickly in a frequently changing environment (e.g., updates to CCQ eligibility, PFE guidelines, or affiliated payer logic).
• Ownership: Take ownership of your assigned queue/book of business, demonstrating drive and initiative to work through issues independently with support from leadership.
• Culture: Understands and embraces the DaVita “community first, company second” culture.

Minimum Qualifications

• High school diploma or equivalent required; bachelor’s degree preferred.
• Revenue cycle experience required (2+ years preferred).
• Deep knowledge of the revenue cycle with a focus on understanding insurance, retro coverage changes, and collections.
• Basic computer skills and proficiency in Microsoft Office (Word, Excel, Outlook).

What We’ll Provide:

For location-specific minimum wage details, see the following link: DaVita.jobs/WageRates