RCMS AR Specialist II

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.

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.
• Mentor Level 1 is associate with advanced AR/Denial management techniques.
• Prepare and submit appeals for denied claims as needed.
• Maintain comprehensive documentation of denial activities and outcomes.
  
  

Requirements

• Associate degree in healthcare administration or related field (preferred).
• Minimum of 2 years of experience in AR/Denial management or revenue cycle management.
• 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.