Supervisor, RCMS

As a Rejection Specialist Team Manager at Qualifacts, you will be responsible for leading and mentoring a team of rejection specialists to ensure productivity and quality targets are consistently met. You will supervise the team, conduct performance reviews regularly, and implement process improvements to enhance efficiency. Collaboration with other Revenue Cycle Management (RCM) teams, such as Billing, Accounts Receivable (AR), and Denials, will be essential to optimize claim processing efficiency. Your role will also involve overseeing daily rejection reports, addressing rejections promptly to prevent claim denials, and identifying recurring rejection patterns. By working closely with the team, you will implement corrective actions to minimize rejections and improve clean claim submission rates. Analyzing rejection trends will be a key aspect of your responsibilities, where you will provide recommendations for process enhancements. Developing and maintaining standard operating procedures (SOPs) for handling various types of rejections will be crucial, along with collaborating with billing, coding, and credentialing teams to reduce avoidable rejections. In terms of reporting and communication, you will prepare and present rejection analysis reports, including root cause analysis and resolution strategies. Accurate documentation of rejection trends, team performance, and corrective actions taken will be maintained to ensure transparency and accountability. To qualify for this role, a Bachelor's degree in Healthcare Administration, Business, or a related field is preferred, along with a minimum of 3-5 years of experience in RCM medical billing, including at least 1-2 years in a supervisory role. Proficiency in EHR systems (e.g., Insync, Credible) and claim management software is required, along with strong analytical skills to identify root causes of rejections and implement improvements efficiently. Problem-solving skills are essential to address complex claim rejections effectively. Preferred qualifications include experience with automated rejection management tools, familiarity with EDI transactions (such as 837, 835, 270, 271, 277, 999, etc.), and knowledge of denial management and coordination with AR teams. At Qualifacts, we are an equal opportunity employer dedicated to fostering diversity and creating an inclusive workplace for all employees.,