RCMS Associate III – Revenue Cycle Management

About the role

Qualifacts is seeking an experienced RCMS Associate III to join its Vadodara office on the night shift. The role focuses on claim rejection analysis, revenue cycle optimization, and stakeholder coordination within a leading behavioral health software company.

Key responsibilities

• Serve as a subject matter expert on claim rejection processes and revenue cycle management strategies.
• Lead projects aimed at reducing claim rejections and improving revenue cycle performance.
• Review, analyze, and resolve clearinghouse claim rejections daily, resubmitting corrected claims within established turnaround times.
• Coordinate with clearinghouse representatives and insurance companies to address systemic issues.
• Track unresolved payer rejections, follow up until closure, and mentor junior associates.

Required profile

• Bachelor's degree in healthcare administration, finance, or a related field.
• Minimum 3 years of extensive experience in revenue cycle management with a focus on claim rejection analysis and resolution.
• Proven track record of implementing process improvements and achieving measurable results.
• Strong leadership, project management, and stakeholder influencing abilities.
• Advanced knowledge of healthcare regulations, reimbursement policies, and industry standards related to billing and claims processing.