RCMS AR Mgmt Specialist

IHCS Technologies India Private Limited; Vadodara; On-site; INR 400,000 - 800,000; Full time

Job summary

Qualifacts is seeking a dedicated professional to manage denial-related activities within the healthcare revenue cycle. The role involves investigating complex denial issues, leading payer calls for escalations, and developing strategies to reduce denial rates and improve reimbursement.

The candidate will collaborate with internal teams to identify root causes, prepare appeals when required, and maintain thorough documentation of all denial activities and outcomes.

Qualifications

• Associate degree in healthcare administration or related field preferred.

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 resolution

Payer calls coordination

Documentation

Education

Associate degree in healthcare administration or related field

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. For more than 20 years, Qualifacts has delivered thoughtful innovation, technology, support, and services to the behavioral health and human services market. Most recently, Qualifacts has been on a mission to expand its portfolio to support the patient continuum, from the initial appointment request to final billing and reporting, and everything in between. Qualifacts has headquarters in Nashville and Tampa with employees across the globe, many with strong healthcare and clinical backgrounds to help bring you the best solutions possible.