Revenue Specialist - Quality Assurance

Make a difference every day at Amoskeag Health, where we believe strong healthcare begins with strong human connections! Who You Are: Amoskeag Health is seeking a Revenue Specialist Quality Assurance to provide workflow support and quality oversight for patient accounting and billing operations.

This position monitors revenue cycle activity, analyzes denials and A/R trends, identifies opportunities for improvement, and ensures accuracy across billing, claims, and payment processes.

Working closely with the Revenue Cycle Manager and other departments, this role supports quality reviews, staff training, and process improvements to promote accurate and timely reimbursement.

What Youll Do: Lead daily revenue cycle workflows, coordinate work queues and coverage, prioritize time-sensitive accounts, and serve as a resource for complex billing and denial issues.

Escalate policy, staffing, and approval decisions to the Revenue Cycle Manager.

Assist with Payer Enrollment when needed.

Analyze A/R aging and trends by payer, service, denial category, and account status.

Monitor days in A/R, aging balances, timely filing exposure, and unresolved claims; identify root causes and recommend prioritized recovery and prevention actions to the Revenue Cycle Manager.

Review the accuracy and completeness of patient demographics, insurance eligibility, payer sequencing, and billing information in the EMR and practice management systems.

Coordinate correction of discrepancies through approved workflows and maintain appropriate audit trails.

Oversee accurate claim generation and submission, review claim edits and rejections, and support correction and resubmission within payer deadlines.

Coordinate documentation or coding questions with authorized clinical and coding personnel.

Coordinate a recurring quality assurance review process for registration, charge capture, claims, payment posting, adjustments, and follow-up.

Use documented review criteria and sampling methods, summarize process-level error trends, and track corrective actions and repeat reviews to confirm improvement.

Maintain current billing procedures, quality checklists, and workflow reference materials.

Provide onboarding, cross-training, and process education; communicate approved payer and system updates to promote consistent practices.

Review daily reconciliation of charges, adjustments, and payments; investigate missing, duplicate, or inconsistent transactions.

Coordinate resolution with billing, finance, and other responsible departments within established approval limits.

Analyze revenue activity, charges, collections, contractual adjustments, and payment variances by payer and service.

Compare period-over-period results and established targets, validate source data, and prepare reports explaining trends, potential underpayments, and opportunities to reduce revenue leakage.

Support accurate posting of Medicare, Medicaid, Blue Cross/Blue Shield, commercial, and other third-party payments and denials...