Patient Access Integrity Specialist

Jackson Health•Miami, FL

22d•Hybrid

About The Position

The Patient Access Integrity Specialist ensures the accuracy, completeness, and regulatory compliance of Patient Access and Revenue Cycle workflows, with emphasis on Financial Clearance and Authorization activities. This role performs daily systematic audits, evaluates performance against defined standards, identifies trends and root causes, and collaborates with operational leaders to support staff education and process improvement. This role plays a critical part in safeguarding data integrity, supporting operational excellence, and reducing downstream denials.

Requirements

Generally requires 2 to 4 years of experience in Revenue Cycle Quality Assurance/Audit roles
High School diploma is required.
Ability to analyze, organize and prioritize work accurately while meeting multiple deadlines.
Ability to communicate effectively in both oral and written form.
Ability to handle difficult and stressful situations with critical thinking and professional composure.
Ability to understand and follow instructions.
Ability to exercise sound and independent judgment.
Knowledge and skill in use of job appropriate technology and software applications.
Valid license or certification is required as needed, based on the job or specialty.
Unit Specific Credential

Nice To Haves

Bachelor's degree in related field is strongly preferred.

Responsibilities

Conduct daily randomized and targeted audits of Patient Access, Financial Clearance, and Authorization accounts using established QA criteria.
Review prior-day audit results to identify priority accounts and issues requiring immediate follow-up.
Validate accuracy and completeness of registration, insurance verification, documentation, and authorization activities.
Escalate correctable errors within remediation windows to prevent downstream denials.
Document audit findings, errors, variances, and root causes in the Quality Assurance system and maintain accurate audit logs.
Analyze audit outcomes to identify recurring errors, workflow gaps, and denial-risk trends.
Review key performance indicators and prepare daily and weekly Quality Assurance summaries, trend reports, and exception analyses for leadership.
Provide timely, constructive feedback to frontline staff and supervisors based on audit findings.
Participate in calibration sessions to ensure scoring consistency across Quality Assurance reviewers.
Support development of training materials, job aids, and remediation plans informed by Quality Assurance trends.
Collaborate with operational and IT teams to refine workflows, update Quality Assurance rubrics, and enhance audit tools and checklists.
Participate in testing and validation of system enhancements affecting Financial Clearance, Authorization, or Quality Assurance processes.
Audit financial clearance activities to ensure accurate completion of eligibility checks, benefit investigations, and pre-service payment estimations.
Validate appropriate use and documentation of financial clearance tools and escalate incomplete or incorrect activities.
Analyze financial clearance trends to identify frequent error sources and opportunities for process improvement.
Review authorization records for completeness, accuracy, and adherence to payer-specific requirements.
Confirm required approvals, documentation of medical necessity, and communications are secured prior to service.
Monitor authorization turnaround times and identify delays or missed tasks that may impact reimbursement.
Identify root causes of authorization-related denials and collaborate with teams to address systemic issues.
Support implementation and optimization of Quality Assurance and Financial Clearance tools and assist in updating playbooks, checklists, and training content.
Perform additional duties as assigned to support departmental quality, compliance, and operational objectives.