Payor Partnerships Specialist

This is a fully remote position, open to applicants in Kentucky, +4 more states.

📋 Description

• Conduct precise and timely reviews of contracts focusing on Best Demonstrated Performance language, checklists, codes, rates, and credentialing operational language.

• Independently investigate and resolve intricate network and claims issues by collaborating with Credentialing Specialists and Negotiation teams.

• Evaluate the root causes of delays or denials utilizing tools such as the A3 worksheet format.

• Analyze complex situations and effectively communicate findings to leadership using the SBAR (Situation, Background, Assessment, Recommendation) format.

• Ensure accurate data maintenance across various systems (Orion, CLM, COR, Salesforce, and IBM-based data systems).

• Generate data for weekly reports, encompassing task categories, email volume, out-of-SLA task assistance, and escalation tracking.

• Maintain an average Quality Assurance (QA) score of 95% or higher for critical errors.

• Develop and sustain strong professional relationships with external payor contacts to enhance processing efficiency.

• Work collaboratively with internal "Partners" to proactively address account issues.

• Handle a substantial volume of work, ensuring email inbox counts remain below 40 and responding to requests within 1-2 business days.

• Prioritize tasks based on risk and value, including Fee For Service Agreements, Document Reviews, Facility Status Requests, New Center Additions, and Acquisitions.

⛳️ Requirements

• A high school diploma or equivalent is required; an Associate’s or Bachelor’s degree is preferred.

• A minimum of 2 years of experience in high-volume research, Customer Accounts management, or complex administrative resolution tasks.

• A demonstrated history of exceptional performance in a production-based environment.

• Advanced Excel skills are necessary: Candidates must possess experience at the formula writing level (e.g., complex IF statements, VLOOKUP, mail merge integration, conditional formatting).

• Strong proficiency in Microsoft Outlook (managing high email volume), Word, PowerPoint, and SharePoint is essential.

• Experience with Salesforce or database management systems is preferred.

🏝️ Benefits

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

• Family support resources: Access to EAP counseling sessions, Headspace ®, backup childcare and elder care, maternity/paternity leave, and more.

• Professional development opportunities: DaVita provides various programs to assist high performers in career growth and offers on-demand virtual leadership and development courses via DaVita’s online training platform, StarLearning.