The Role
Investigate and resolve complex AR and claim denials, analyze denial trends, lead escalated payer calls, prepare appeals, mentor Level 1 associates, implement strategies to reduce aging accounts and denials, and maintain detailed denial documentation.
Summary Generated by Built In
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.
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.
- Investigate AR/Denial issues: Resolve complex accounts receivable and denial cases with thorough analysis.
- Analyze denial trends: Identify recurring issues and recommend process improvements.
- Lead payer calls: Initiate and manage escalated discussions with payers to resolve disputes.
- Develop strategies: Implement solutions to reduce aging accounts and denial rates, improving reimbursement outcomes.
- Collaborate with stakeholders: Work cross-functionally to address root causes of denials.
- Mentor associates: Train and guide Level 1 team members on advanced denial management techniques.
- Prepare appeals: Draft and submit appeals for denied claims when necessary.
- Maintain documentation: Ensure comprehensive records of denial activities and outcomes.
- Education: Associate degree in healthcare administration or related field (preferred).
- Experience: Minimum of 2+ years in denial management or revenue cycle management.
- Technical skills: Proficiency in medical billing software and denial tracking systems.
- Analytical ability: Strong problem-solving and analytical skills.
- Communication: Ability to negotiate claim resolutions with payers.
- Leadership: Demonstrated leadership skills and ability to work independently.
Qualifacts is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.
Skills Required
- Minimum 2+ years in denial management or revenue cycle management
- Proficiency in medical billing software and denial tracking systems
- Strong problem-solving and analytical skills
- Ability to negotiate claim resolutions with payers
- Demonstrated leadership skills and ability to work independently
- Associate degree in healthcare administration or related field
- Onsite work in Vadodara office, 5 days/week, Night/US shift (6:30pm-3:30am IST)
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The Company
What We Do
Qualifacts' CareLogic Enterprise Software is a comprehensive Electronic Health Record (EHR) designed for behavioral health, mental health, & human services.
