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 cutting-edge 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.

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 3+ ye

📌 RCMS AR Specialist III (Vadodara)
🏢 Qualifacts
📍 Vadodara