RCMS Denials Analyst III

Qualifacts; Gujarat; On-site; INR 800,000 - 1,500,000; Full time

Job summary

Qualifacts Systems Inc. in Gujarat, India is seeking an experienced AR/Denials Manager to lead resolution of escalated billing issues, manage payer calls, and drive revenue cycle improvements.

The role requires a Bachelor's in Healthcare Administration or Finance and at least 5 years in AR/Denials, with strong regulatory knowledge and leadership. You will mentor teammates and collaborate with leaders to monitor KPIs and ensure billing accuracy.

Qualifications

• Bachelor's degree in Healthcare Administration, Finance, or a related field.
• Minimum 5 years of progressive experience in AR/Denials Management.
• Strong knowledge of healthcare billing regulations, payer guidelines, and compliance standards.
• Proven leadership, coaching, and mentoring abilities.
• Excellent communication, presentation, and stakeholder management skills.
• Proficiency in data analysis, reporting, and performance-tracking tools.
• Ability to drive process improvements and implement change effectively.
• Strong analytical, problem-solving, and decision-making capabilities.

Responsibilities

• Lead the resolution of escalated billing issues and payer disputes.
• Manage payer calls for complex billing inquiries, negotiations, and disputes.
• Develop and implement strategies to improve revenue cycle efficiency and effectiveness.
• Conduct regular audits to ensure billing accuracy and compliance.
• Provide training, mentorship, and ongoing support to junior associates and team members.
• Collaborate with leadership to develop, track, and monitor KPIs.
• Stay updated on industry trends, regulatory changes, and revenue cycle management best practices.

Skills

Leadership

Coaching

Mentoring

Communication

Stakeholder management

Data analysis

Regulatory awareness

Problem solving

Education

Bachelor's degree in Healthcare Administration, Finance, or related field

Job description

Responsibilities

• Lead the resolution of escalated billing issues and payer disputes.
• Manage payer calls for complex billing inquiries, negotiations, and dispute resolution.
• Develop and implement strategies to improve revenue cycle efficiency and effectiveness.
• Conduct regular audits to ensure billing accuracy and compliance.
• Provide training, mentorship, and ongoing support to junior associates and team members.
• Collaborate with leadership to develop, track, and monitor key performance indicators (KPIs).
• Stay updated on industry trends, regulatory changes, and revenue cycle management best practices.

Requirements

• Bachelor's degree in Healthcare Administration, Finance, or a related field.
• Minimum 5 years of progressive experience in AR/Denials Management
• Strong knowledge of healthcare billing regulations, payer guidelines, and compliance standards.
• Proven leadership, coaching, and mentoring abilities.
• Excellent communication, presentation, and stakeholder management skills.
• Proficiency in data analysis, reporting, and performance-tracking tools.
• Ability to drive process improvements and implement change effectively.
• Strong analytical, problem-solving, and decision-making capabilities.

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