Patient Access Quality & Improvement Specialist

Luminis Health

Title:  Patient Access Quality & Improvement Specialist

Position Objective

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.

Essential Functions:

1.     Audit and Quality Review

a.     Conduct regular audits of hospital-based registration, insurance verification, and financial clearance activities in Epic.

b.     Review DNB (Do Not Bill), insurance verification, and registration error work queues to identify issues requiring correction or rework.

c.      Validate demographic, insurance, authorization, and patient type accuracy at time of registration or admission.

2.     Root-Cause and Denial Analysis

a.     Trace patient accounts through the registration-to-billing cycle to identify the source of errors that lead to denials or rework.

b.     Partner with Denial Management, PFS, and Revenue Integrity to evaluate and trend denial data tied to front-end registration or eligibility issues.

c.      Document and categorize findings by error type, staff, and department to detect patterns and systemic opportunities.

3.     Data Tracking and Reporting

a.     Maintain and update audit tracking logs; produce monthly dashboards and error-rate summaries for leadership review.

b.     Analyze error trends and collaborate with Patient Access leadership to prioritize re-education or process redesign initiatives.

c.      Prepare summaries highlighting measurable improvements following staff or process interventions.

4.     Training and Education Support

a.     Collaborate with Patient Access Trainers to develop targeted retraining based on audit results.

b.     Provide individual feedback to registrars or financial counselors as appropriate, ensuring corrective action and accountability.

c.      Support continuous education through process tip sheets, Epic job aids, and best-practice refreshers.

5.     Process and Compliance Improvement

a.     Identify workflow inefficiencies, documentation gaps, or Epic configuration issues impacting registration accuracy.

b.     Recommend process improvements that reduce registration-related denials and improve throughput.

c.      Ensure compliance with internal policies and regulatory requirements (e.g., Maryland Financial Assistance Law, Good Faith Estimate, MSPQ, consent workflows).

Performance Metrics

·        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.

Educational/Experience Requirements:

·        Minimum 3 years in hospital patient access, registration, insurance verification, or financial clearance required

·        Proficiency in Epic registration and work queue navigation required; 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.

Required License/Certifications:

·        CHAA (Certified Healthcare Access Associate) or CHAM (Certified Healthcare Access Manager) preferred.

·        CPAS, CPFSS, CRCL within 1 year of hire (provided by organization)

Working Conditions, Equipment, Physical Demands:

There is a reasonable expectation that employees in this position will not be exposed to blood-borne pathogens.

Physical Demands –

The physical demands and work environment that have been described are representative of those an employee encounters while performing the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions in accordance with the Americans with Disabilities Act.

The above job description is an overview of the functions and requirements for this position.  This document is not intended to be an exhaustive list encompassing every duty and requirement of this position; your supervisor may assign other duties as deemed necessary.