Specialist II, Contract Operations

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🔥 0 minutes ago

🏈 Alabama, Iowa, +3 more states – Remote

🏈 Alabama – Remote 🌾 Iowa – Remote 🌶️ New Mexico – Remote ❄️ Minnesota – Remote ☕ Washington – Remote

💵 $22 - $28 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

⚙️ Operations

🚫👨‍🎓 No degree required

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DaVita Kidney Care

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1994

⚕️ Healthcare Insurance

💰 Post-IPO Debt on 2021-02

Healthcare Insurance

DaVita Kidney Care is a leading healthcare company that provides dialysis and related treatments for patients with kidney disease. Committed to improving the quality of life for its patients, DaVita focuses on offering integrated kidney care and supporting its diverse team of healthcare professionals, including nurses, dietitians, social workers, and patient care technicians. The company emphasizes a strong culture, career development, and comprehensive benefits to create an inclusive and supportive work environment for its employees.

📋 Description

• Accurate and timely contract reviews with regards to Best Demonstrated Performance language, check lists, codes, rates, and credentialing operational language • Independently research and resolve complex network and claims issues by collaborating with Credentialing Specialists and Negotiation teams • Analyze root causes of delays or denials using tools such as the A3 worksheet format • Assess complex situations and communicate effectively to leadership using the SBAR (Situation, Background, Assessment, Recommendation) format • Maintain accurate data across multiple systems (Orion, CLM, COR, Salesforce, and IBM-based data systems) • Provide data for weekly reports, including task categories, email volume, out of SLA task assistance and escalation tracking • Maintain an average Quality Assurance (QA) score at or above 95% for critical errors • Build and maintain strong professional relationships with external payor contacts to facilitate efficient processing. • Collaborate with internal " Partners" to proactively resolve account issues • Manage an extremely high volume of work, including maintaining email inbox counts below 40 and responding to requests within 1-2 business days.

🎯 Requirements

• High school diploma or equivalent required; Associate’s or Bachelor’s degree preferred • Minimum 2 years of experience in high-volume research, Customer Accounts ownership or complex administrative resolution work • Proven track record of top performance in a production-based environment • Advanced Excel Skills Required: Must have 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 • Experience with Salesforce or database management systems preferred.

🏖️ Benefits

• 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 DaVita’s online training platform StarLearning.