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 working the NIGHT SHIFT. Hours are 6:30pm-3:30am IST. Remote applicants will not be considered.

Core Functions:

Accounts Receivable (AR) Management:

• Oversee all AR functions, including the monitoring of aging reports, follow-up on outstanding claims, and the resolution of unpaid balances.

• Develop strategies to reduce days in accounts receivable (DAR) and improve the overall cash flow.

• Ensure timely and accurate posting of payments and adjustments to maintain clean accounts and accurate financial records.

• Monitor and report on key performance indicators (KPIs) related to AR, such as collections rate, aging bucket performance, and AR days.

Denial Management:

• Develop and implement robust denial management processes to minimize claim denials and optimize revenue recovery.

• Analyze denial trends and work closely with coding, billing, and clinical teams to address root causes and implement corrective actions.

• Establish and maintain denial prevention strategies, including pre-claim submission audits and training programs for staff on proper documentation and coding practices.

• Work with insurance payers to negotiate and resolve denied or underpaid claims, ensuring maximum reimbursement.

Leadership and Team Development:

• Lead and mentor a team of AR specialists, denial management analysts, and billing staff, fostering a culture of continuous improvement and excellence.

• Set clear performance goals and provide regular feedback and coaching to ensure team members meet or exceed expectations.

• Conduct regular training sessions to enhance team members’ skills in AR management and denial resolution.

Compliance and Quality Assurance:

• Ensure compliance with federal, state, and payer-specific regulations and guidelines related to AR and denial management.

• Collaborate with the compliance team to conduct periodic audits and ensure adherence to best practices in billing, coding, and collections.

• Implement quality control measures to reduce errors and improve the accuracy of claims processing and payment posting.

Process Improvement and Technology Utilization:

• Identify opportunities for process improvements within AR and denial management to enhance efficiency and reduce operational costs.

• Work with IT and other departments to optimize the use of billing and AR management software, including EHR systems and other relevant tools.

• Stay updated on industry trends and changes in payer policies to proactively adjust processes and maintain high performance.

Financial Analysis and Reporting:

• Prepare and present regular reports on AR performance, denial rates, and revenue trends to senior management.

• Conduct financial analysis to identify opportunities for revenue enhancement and cost reduction within the AR and denial management functions.

• Develop and manage budgets for the AR and denial management teams, ensuring resources are allocated effectively to meet organizational goals.

Qualifications:

• Education: Bachelor’s degree in healthcare administration, business, finance, or related field. Master’s degree preferred.

• Experience: Minimum of 7-10 years of experience in revenue cycle management, specifically in AR and denial management, with at least 3 years in a leadership role.

• Skills:

• Extensive knowledge of medical billing and coding, payer guidelines, AR management, and denial resolution.

• Strong leadership skills with experience managing teams and driving performance improvement.

• Proficiency in using RCM software, EHR systems, and data analytics tools.

• Excellent analytical, problem-solving, and communication skills, with a focus on data-driven decision-making.

Key Competencies:

• Leadership: Ability to lead and inspire teams to achieve organizational goals related to AR and denial management.

• Analytical Thinking: Strong analytical skills to assess data, identify trends, and implement effective solutions.

• Communication: Clear and effective communication skills to work with internal teams and external payers.

• Adaptability: Ability to adapt to changes in regulations, payer requirements, and industry trends.

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