Patient Access Quality & Improvement Specialist

Patient Access Quality & Improvement Specialist

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The Patient Access Quality & Improvement Specialist is responsible for auditing, analyzing, and improving front-end registration, insurance verification, and financial clearance processes across hospital-based patient access areas. This position monitors quality within Epic work queues (including DNB, registration error, and eligibility queues), traces patient account workflows to identify root causes of errors and denials, and collaborates with leadership and trainers to develop re-education plans that improve accuracy and efficiency.

Unlike a general quality assurance role, this position is embedded within Patient Access operations, focusing on preventing revenue leakage and denials through accurate front-end processes rather than downstream billing or call‑center performance.

• Audit and Quality Review:
  Conduct regular audits of hospital-based registration, insurance verification, and financial clearance activities in Epic.
• Review DNB (Do Not Bill), insurance verification, and registration error work queues to identify issues requiring correction or rework.
• Validate demographic, insurance, authorization, and patient type accuracy at time of registration or admission.
• Root-Cause and Denial Analysis:
  Trace patient accounts through the registration-to-billing cycle to identify the source of errors that lead to denials or rework.
• Partner with Denial Management, PFS, and Revenue Integrity to evaluate and trend denial data tied to front-end registration or eligibility issues.
• Document and categorize findings by error type, staff, and department to detect patterns and systemic opportunities.
• Data Tracking and Reporting:
  Maintain and update audit tracking logs; produce monthly dashboards and error-rate summaries for leadership review.
• Analyze error trends and collaborate with Patient Access leadership to prioritize re-education or process redesign initiatives.
• Prepare summaries highlighting measurable improvements following staff or process interventions.
• Training and Education Support:
  Collaborate with Patient Access Trainers to develop targeted retraining based on audit results.
• Provide individual feedback to registrars or financial counselors as appropriate, ensuring corrective action and accountability.
• Support continuous education through process tip sheets, Epic job aids, and best-practice refreshers.
• Process and Compliance Improvement:
  Identify workflow inefficiencies, documentation gaps, or Epic configuration issues impacting registration accuracy.
• Recommend process improvements that reduce registration-related denials and improve throughput.
• Ensure compliance with internal policies and regulatory requirements (e.g., Maryland Financial Assistance Law, Good Faith Estimate, MSPQ, consent workflows).

• Reduction in registration or verification error rate over defined periods.
• Percentage of DNB and error work queue items resolved within targeted timelines.
• Reduction in denials attributed to front-end registration or eligibility errors.
• Number and timeliness of audit reports delivered to leadership.
• Documented improvement following re-education interventions.

• Minimum 3 years in hospital patient access, registration, insurance verification, or financial clearance.
• Proficiency in Epic registration and work queue navigation; experience with reporting or analysis tools (Excel, Power BI, or similar) preferred.
• Strong understanding of patient registration workflows, insurance plan structures, MSPQ logic, authorization processes, and denial root-cause principles.
• Analytical and detail-oriented; able to trace multi-step account workflows; excellent written and verbal communication; capable of providing professional feedback.
• Associate’s degree required;
  Bachelor’s preferred.

• CHAA (Certified Healthcare Access Associate) or CHAM (Certified Healthcare Access Manager) preferred.
• CPAS, CPFSS, CRCL within 1 year of hire (provided by organization).