RCMS AR Mgmt Specialist

Qualifacts; Vadodara; On-site; INR 350,000 - 550,000; Full time

Job summary

Qualifacts Systems Inc. is seeking a denial management professional to investigate and resolve complex denial issues, analyze denial trends, and lead payer calls for escalated inquiries.

The role focuses on developing strategies to reduce denial rates and improve reimbursement while collaborating across internal teams. The ideal candidate will manage appeals, document denial activities, and work with stakeholders to address root causes of denials, ensuring accurate and timely submissions in a

Qualifications

• Experience with healthcare denial management preferred.
• Strong analytical and problem-solving abilities.
• Excellent communication with payers and internal teams.

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.

Skills

Denial management

Claims analysis

Payer coordination

Documentation

Education

Associate degree in healthcare administration

Job description

Job Description:

Job Description:

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.

Requirements

• Associate degree in healthcare administration or a related field (preferred).

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