Supervisor, RCMS Charges

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:

The RCM Charges Supervisor oversees the team responsible for accurately capturing and entering charges for medical services rendered. They ensure adherence to billing regulations, manage workflow efficiency, and provide guidance to associates. The supervisor also collaborates with other departments to resolve billing discrepancies and optimize revenue cycle processes.

Supervision and Leadership:

• Lead and mentor a team of RCM Charges Associates.
• Provide training on billing procedures, software systems, and compliance standards.
• Conduct regular performance evaluations and provide feedback for professional development.
• Foster a collaborative and supportive work environment to maximize team productivity.

Charge Capture and Entry:

• Oversee the timely and accurate capture and entry of charges for medical services.
• Ensure compliance with coding guidelines, payer requirements, and regulatory standards.
• Review charge entry processes to identify areas for improvement and implement necessary changes.
• Resolve complex coding issues and escalate discrepancies as needed.

Quality Assurance:

• Conduct audits to verify the accuracy and completeness of charge entries.
• Develop and maintain quality assurance procedures to minimize errors and ensure compliance.
• Provide ongoing training and support to address identified deficiencies and improve performance.

Payer Communication:

• Collaborate with payer representatives to address billing inquiries, disputes, and reimbursement issues.
• Facilitate regular communication with payers to stay informed of changes in billing policies and procedures.
• Negotiate payment terms and resolve disputes to maximize revenue recovery.

Reporting and Analysis:

• Generate and analyze reports to monitor key performance indicators, such as charge lag and denial rates.
• Identify trends and patterns in charge data to inform decision-making and process improvement efforts.
• Develop actionable insights and recommendations to optimize revenue cycle performance.

Process Improvement:

• Continuously evaluate and streamline charge capture and entry processes to enhance efficiency and accuracy.
• Implement best practices and innovative solutions to drive operational excellence.
• Collaborate with cross-functional teams to identify opportunities for revenue enhancement and cost reduction.

Requirements:

• Bachelor's degree in healthcare administration, business, or related field (preferred).
• Minimum of 3-5 years of experience in medical billing, with a focus on charge capture and entry.
• Proficiency in medical coding systems (e.g., CPT, ICD-10) and billing software.
• Strong understanding of healthcare billing regulations, compliance standards, and payer policies.
• Excellent leadership and interpersonal skills, with the ability to motivate and inspire a team.
• Analytical mindset with the ability to interpret data and make data-driven decisions.
• Effective communication and negotiation skills, with the ability to interact professionally with internal and external stakeholders.
• Detail-oriented approach with a commitment to accuracy and quality assurance.
• Proven track record of driving process improvements and achieving measurable results in revenue cycle management.
• Certification in medical coding (e.g., CPC) or revenue cycle management (e.g., CRCR) is a plus.

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.