RCMS AR Technical Lead

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. 

SME Key Responsibilities

AR & Claims Management

Handle complex and escalated AR cases related to denials, underpayments, rejections, and appeals.

Perform insurance follow-ups with commercial, Medicare, Medicaid, and managed care payers.

Analyze Explanation of Benefits (EOBs) and Electronic Remittance Advice (ERA) to identify discrepancies.

Ensure timely resolution of outstanding claims to minimize AR aging and maximize collections.

Denial Management & Appeals

Identify root causes of denials and recommend corrective actions.

Prepare, review, and submit appeals with appropriate documentation.

Track denial trends and share insights to reduce recurrence.

SME Support & Team Enablement

Act as a subject matter expert for AR workflows, payer rules, and reimbursement methodologies.

Support team members with technical guidance, case reviews, and issue resolution.

Assist in training new hires and upskilling existing team members.

Participate in quality audits and provide feedback for performance improvement.

Process Improvement & Reporting

Monitor AR KPIs such as aging, denial rates, productivity, and collection performance.

Identify process gaps and contribute to workflow optimization initiatives.

Collaborate with operations, billing, coding, and front-end teams to improve first-pass yield.

Support documentation of SOPs and payer-specific guidelines.

Compliance & Documentation

Ensure compliance with HIPAA, payer contracts, and organizational policies.

Maintain accurate documentation of account activities and payer communications.

Required Qualifications

3+ years of experience in RCM AR, insurance follow-ups, and denial management.

Strong knowledge of US healthcare billing, reimbursement, and payer guidelines.

Hands-on experience with EOB/ERA analysis and appeals processes.

Preferred Skills & Competencies

Strong analytical and problem-solving skills.

Excellent written and verbal communication skills.

Ability to mentor and support team members.

Proficiency in AR workflows and revenue cycle metrics.

Experience with practice management systems and clearinghouses.

Key Performance Indicators (KPIs)

Reduction in AR aging (>90 days)

Denial resolution rate and turnaround time

Net collection rate improvement

First-pass resolution and appeal success rate

Work Environment

Fast-paced healthcare revenue cycle operations environment

Collaboration with cross-functional teams

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