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RCMS Denials Analyst II

qualifacts ¡ Vadodara
// classified as
Other (Adjacent or hard to classify.)
posted
1d ago
location
Vadodara
languages
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tools
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> description

Job Description:

Job Description

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 CareLogic®, Credible™, and InSync® 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.

Responsibilities:

  • Investigate and resolve complex denial issues.

  • Analyze denial trends to identify opportunities for process improvement.

  • Initiate and lead payer calls for escalated denial inquiries, follow-ups, and

disputes.

  • Develop and implement strategies to reduce denial rates and enhance

reimbursement.

  • Collaborate with internal stakeholders to address root causes of denials.

  • Prepare and submit appeals for denied claims as needed.

  • Maintain comprehensive documentation of denial activities and outcomes.

  • Address denials at the root cause by requesting appropriate rules and system

edits after partner approval.

  • Identify and analyze denial trends and escalate to supervisor for further

resolution.

Requirements:

  • Bachelor’s degree in any discipline.

  • Strong problem-solving and analytical skills and work towards resolution.

  • Candidates with 1-2 years of experience in Accounts Receivable (AR) & Denial

Management

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

Apply at qualifacts →