RCMS Associate III

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.

As one of the largest EHR companies in the country, Qualifacts offers revolutionary support for behavioral health, human services, and rehabilitative services. The technology and solutions that we provide enhance how our customers deliver quality care, make it possible for them to achieve exceptional outcomes, and improve the lives of the individuals they serve. We draw upon 20 years of experience to inform our products and services, and the result is solutions that empower our customers to achieve interoperability goals, optimize efficiency, improve productivity, and maximize reimbursement. 

Qualifacts supports three platforms: CareLogic, Credible, and InSync. The EHR platforms, each uniquely positioned, allow us to serve all segment sizes within the market. 

If you want to work inside an atmosphere where innovation has purpose, and your ambition works to support our customers and those they serve, please apply today! 

This is an onsite position, 5 days/week, in the Vadodara office working the NIGHT SHIFT. Hours are 6:30pm-3:30am IST. Remote applicants will not be considered. 

Job Description: RCM Rejection Associate (Senior Level)

• Serve as a subject matter expert on claim rejection processes and revenue cycle management strategies.
• Lead projects or initiatives aimed at optimizing revenue cycle performance and reducing claim rejections.
• Review and resolve clearinghouse claim rejections on a daily basis.
• Analyze rejection trends and identify root causes.
• Resubmit corrected claims within established turn around times.
• Coordinate with clearinghouse representatives for issue resolution.

• Investigate and resolve payer-specific claim rejections
• Track unresolved payer rejections and follow up until closure.
• Develop and maintain relationships with key stakeholders, such as insurance companies, to address systemic issues impacting claim acceptance.
• Mentor junior associates and provide guidance on complex rejection scenarios or industry changes.
  

Skills/Qualifications

• Bachelor's degree in healthcare administration, finance, or a related field.
• Extensive experience in revenue cycle management, with a focus on claim rejection analysis and resolution. (3+ years)
• Proven track record of implementing successful process improvements and achieving measurable results in revenue cycle performance.
• Strong leadership and project management skills, including the ability to influence stakeholders and drive change initiatives.
• Advanced knowledge of healthcare regulations, reimbursement policies, and industry standards related to billing and claims processing.

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