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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. If you want to work inside an atmosphere where innovation has purpose, and your ambition works to support our customers and those they serve, please apply today! 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. Summary of the Director, RCMS India Operations The Director of Revenue Cycle Management (RCM) will be responsible for leading and optimizing end-to-end revenue cycle operations for the company s US-based healthcare clients. This role requires deep expertise in US healthcare RCM processes, including medical billing, coding, insurance claims, accounts receivable (A/R) management, denials management, and compliance. The Director will drive process efficiency, ensure regulatory adherence, implement automation solutions, and lead a high-performing team to achieve revenue and operational goals. Responsibilities for the Director, RCMS India Operations Strategic Leadership Operations Oversee and manage the entire revenue cycle function, including charge capture, billing, prior-authorization, collections, and payment posting Develop and implement best practices, policies, and workflows to optimize revenue cycle performance and ensure compliance with US healthcare regulations Collaborate with US-based stakeholders, including providers, payers, and leadership teams, to align RCM strategies with business goals Drive automation and process improvement initiatives leveraging technology, analytics, and AI-driven solutions Team Management Performance Optimization Lead, mentor, and develop a team of RCM professionals, including medical billers, payment posting specialists, and A/R follow-up analysts Set performance metrics, monitor KPIs, and ensure achievement of key revenue cycle objectives, such as reducing A/R days and improving collection rates Foster a culture of accountability, continuous learning, and process excellence within the team Revenue Compliance Management Ensure compliance with US healthcare laws, including HIPAA, CMS guidelines, and payer regulations Analyze revenue cycle trends, identify revenue leakage, and implement corrective actions to improve financial outcomes Develop and maintain strong payer relationships to optimize reimbursement and resolve claim disputes. Technology Process Improvement Partner with technology teams to implement and optimize RCM tools, EHR systems, and automation solutions. Leverage data analytics and reporting to drive decision-making and enhance revenue cycle performance. Stay updated on industry trends, regulatory changes, and emerging technologies in healthcare RCM. Qualifications of the Director, RCMS India Operations Advanced degree in Business Administration, Healthcare Management, Finance, or a related field Minimum 12+ years of experience in US healthcare RCM, with at least 5+ years in a senior leadership role Expertise in US Healthcare RCM and a strong knowledge of medical billing, coding (CPT, ICD-10, HCPCS), payer regulations, claims adjudication, and reimbursement methodologies (Medicare, Medicaid, commercial payers) Proven experience in managing large RCM teams and driving performance improvements. Experience with EHR/RCM systems (Qualifacts, Epic, Cerner, Athenahealth, NextGen, etc.) and automation tools like RPA/AI in RCM processes. Knowledge, Skills, and Abilities of the Director, RCMS India Operations Strong ability to problem solve, analyze revenue cycle data, identify trends, and implement process enhancements Deep understanding of HIPAA, CMS guidelines, and payer-specific policies for compliance and regulatory purposes Excellent communication and stakeholder management and the ability to work with US-based leadership, clients, and cross-functional teams. Certifications such as Certified Revenue Cycle Representative (CRCR), Certified Professional Coder (CPC), or Certified Revenue Cycle Executive (CRCE), preferred Experience in healthcare technology firms, BPO/KPO, or RCM service providers catering to US healthcare clients, preferred Dynamic and collaborative work environment with exposure to global healthcare markets, preferred Qualifacts is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.
