RCMS AR Specialist I

Qualifacts is a leading provider of behavioral health software and SaaS solutions for clinical productivity, compliance and state reporting, billing, and business intelligence. Its mission is to be an innovative and trusted technology and end-to-end solutions partner, enabling exceptional outcomes for its customers and those they serve. Qualifacts comprehensive portfolio, including the CareLogicregistered, Credibletrade mark, and InSyncregistered platforms, spans and serves the entire behavioral health, rehabilitative, and human services market supporting non-profit Certified Community Behavioral Health Clinics (CCBHC) as well as for-profit large enterprise and small business providers. Qualifacts has a loyal customer base, with more than 2,500 customers representing 75,000 providers serving more than 6 million patients. Qualifacts was recognized in the 2022 and 2023 Best in KLAS: Software and Services report as having the top ranked Behavioral Health EHR solutions.

This is an onsite position, 5 days/week, in the Vadodara office.

Shift: -NIGHT/US SHIFT. 6:30pm-3:30am IST.

Remote applicants will not be considered.

Responsibilities

• Investigate and resolve complex claim denial issues.
• Analyze denial trends and identify opportunities for process improvement.
• Initiate and lead payer calls for escalated denial inquiries, follow-ups, and dispute resolution.
• Develop and implement strategies to reduce denial rates and improve reimbursement outcomes.
• Collaborate with internal teams to identify and address the root causes of denials.
• Prepare, submit, and track appeals for denied claims.
• Maintain accurate and comprehensive documentation of denial activities, actions taken, and outcomes.
• Monitor accounts receivable and ensure timely follow-up on outstanding denials.

• Associate degree in Healthcare Administration or a related field preferred.
• 0–1 year of experience in Accounts Receivable (AR), Denial Management, or Revenue Cycle Management.
• Basic understanding of medical billing, insurance claims, and denial management processes.
• Strong analytical and problem-solving skills.
• Excellent communication

Qualifacts is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.