Job Description

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 AR and denial-related issues
Analyze denial trends to identify opportunities for process improvement
Initiate and lead payer calls for escalated denial inquiries and disputes
Develop and implement strategies to reduce aging and denial rates and improve reimbursement
Collaborate with internal stakeholders to identify and address root causes of denials
Mentor Level 1 associates on advanced AR and denial management techniques
Prepare and submit appeals for denied claims as required
Maintain thorough documentation of denial activities and resolution outcomes

Requirements

Associate degree in Healthcare Administration or a related field (preferred)
Minimum of 2 years of experience in denial management or revenue cycle management
Proficiency in medical billing software and denial tracking systems
Strong analytical and problem‑solving skills
Ability to communicate effectively with payers to negotiate claim resolutions
Demonstrated leadership skills and ability to work independently

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

RCMS AR Specialist II