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 You’ll 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. Review unpaid claims within 45 days or sooner when required by payer deadlines; coordinate corrected claims, appeals, and follow-up, and retain supporting documentation.

· Act as a designated liaison with payer and managed care representatives to resolve recurring claim, reimbursement, and enrollment issues. Monitor membership additions and deletions and communicate discrepancies affecting billing.

· Partner with registration, clinical, coding, finance, and information technology teams to strengthen EMR data integrity and documentation-to-billing workflows. Identify missing encounters, charge discrepancies, duplicate records, and interface issues; route corrections to authorized personnel and support testing and validation of system changes without independently altering clinical documentation.

· Prepare recurring revenue cycle and quality dashboards covering A/R aging, denial and rejection trends, clean claims, payment accuracy, and corrective action status. Present findings and recommendations to the Revenue Cycle Manager, coordinate approved process improvements, and monitor results using consistent metric definitions.

· Protect patient and financial information, follow applicable privacy and security requirements and organizational policies, and promptly escalate suspected billing inaccuracies or compliance concerns. Apply established authorization requirements for adjustments, refunds, and account corrections.

· Interact with clients in a positive and professional manner; sensitive in approach to discussions with clients regarding financial matters.

· Support the goals and mission of Amoskeag Health.

· Actively attend and participate in Health Center meetings, as directed. If absent, responsible for reading minutes of meetings and signing the documentation.

· Responsible for the collection of bad debt.

What You'll Bring:

· Associate’s or Bachelor’s degree in Business, Finance, Healthcare Administration, or equivalent combination of education and experience required.

· Medical billing and coding certifications preferred

· A minimum of three (3) years of experience in healthcare billing and revenue cycle experience required, including hands-on work with A/R follow-up, denial resolution, payment posting, and reconciliation. Demonstrated experience analyzing revenue and A/R trends and conducting billing quality reviews required.

· Prior workflow coordination, staff training, or quality improvement experience preferred