RCMS Denials Analyst I

IHCS Technologies India Private Limited; Vadodara; On-site; INR 600,000 - 900,000; Full time

Job summary

Qualifacts seeks a denial management professional to investigate and resolve complex denial issues for our healthcare billing operations in Vadodara. The role focuses on analyzing denial trends, initiating payer calls, and implementing strategies to reduce denials and improve reimbursement.

You will collaborate with internal teams, prepare appeals, and maintain thorough documentation while ensuring accuracy and timely reporting in a fast-paced, night-shift environment.

Qualifications

• Associate degree in healthcare administration or related field.
• 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.

Responsibilities

• Investigate and resolve complex denial issues.
• Analyze denial trends to identify areas for process improvement.
• Initiate and lead payer calls for escalated denial inquiries, follow-up and disputes.
• Develop and implement strategies to reduce denial rates and improve 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 outcome.

Skills

Medical billing software

Analytical skills

Communication with payers

Leadership

Attention to detail

Education

Associate degree in healthcare administration

Tools

Denial tracking systems

Medical billing software

Job description

Job Description: 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.

Responsibilities

• Investigate and resolve complex denial issues.
• Analyze denial trends to identify areas for process improvement.
• Initiate and lead payer calls for escalated denial inquiries, follow-up and disputes.
• Develop and implement strategies to reduce denial rates and improve 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 outcome.

Requirements

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

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.