RCM AR Specialist II

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,

Time, NIGHT SHIFT. Hours are 6 : 30 pm-3 : 30 am IST,

Responsibilities for the RCMS AR Specialist II

The roles and responsibilities may encompass a broad spectrum, extending beyond the following tasks :

Pursuing Accounts Receivable (AR) follow-ups, involving interactions with insurance companies, utilizing website resources, and other relevant methods.

Scrutinizing and overseeing the historical data of claims.

Conducting eligibility verifications.

Resubmitting claims as necessary.

Updating demographic and insurance information.

Addressing escalated issues and identifying trends.

Upholding and monitoring Quality scores and accuracy levels.

Maintaining comprehensive logs of AR issues.

Achieving set Turnaround Time (TAT) and adhering to quality standards.

Adhering to established practice guidelines.

Monitoring personal productivity, tracking day-to-day task workloads.

Undertaking any other duties as required

Knowledge, Skills, and Abilities

Proficiency in medical billing software and denial tracking systems.

Strong problem-solving and analytical skills.

Ability to effectively communicate with payers to negotiate claim resolutions.

Leadership skills and ability to work independently.

Attention to detail and accuracy in data analysis and reporting.

Qualifications

Min. 2 years of experience in AR / Denial management or Revenue Cycle Management, US Healthcare.

Bachelor’s degree in healthcare or related field (or equivalent experience)