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INTRODUCTION

The Quality Assurance Specialist supports the Patient Access Department by ensuring accuracy, compliance, and consistency across registration, scheduling, insurance verification, and authorization processes. This role evaluates the accuracy and completeness of patient access workflows to ensure compliance with established standards and organizational policies. Conducts detailed audits, prepares audit reports, and monitors process quality to promote clean claims and minimize payment denials. Analyzes audit findings to identify trends, areas of concern, and opportunities for improvement, develops recommendations and quality improvement plans accordingly. Maintains and updates quality assurance tools to reflect current patient access workflow requirements and provides timely support and documentation in response to audit-related inquiries.

PRIMARY RESPONSIBILITIES

The following statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all job responsibilities performed.

• Perform regular routine and ad hoc audits of patient access workflows, including registration accuracy, scheduling, insurance verification, authorization, and financial clearance records to evaluate data accuracy, completeness, and compliance with established quality standards.
• Prepare detailed audit reports summarizing findings, trends, and performance metrics for individual team members and the leadership team.
• Develop and distribute monthly quality reports comparing actual audit results to benchmarks, identifying key areas of concern for improvement.
• Respond promptly to inquiries regarding audit results, providing supporting documentation and clarification as needed.
• Investigate and resolve patient access-related discrepancies or errors; recommend process changes to ensure accuracy and data integrity.
• Monitor and audit registration accuracy, scheduling, insurance verification, and authorization within financial systems to support clean claims submission and minimize payment denials.
• Develop recommendations for quality improvement plans. Collaborate with registration, scheduling, billing, and training to develop and implement quality improvement plans based on audit findings.
• Review and update the Quality Assurance (QA) tool to ensure it reflects current patient access standards and process by capturing changes.
• Track and report on quality trends over time, providing data-driven insights to support process improvement initiatives.
• Support and/or participate in the development and delivery of staff training sessions focused on patient access workflows, accuracy and quality improvement.
• Maintain confidentiality of sensitive data and ensure compliance with organizational policies and applicable regulations.
• Perform all other duties as assigned.

EDUCATION & EXPERIENCE - REQUIRED

• High school diploma or equivalent
• Minimum two (2) years previous healthcare registration experience

EDUCATION & EXPERIENCE - PREFERRED

• Associate’s degree
• Previous EPIC experience

KNOWLEDGE, SKILLS, & ABILITIES

• Knowledge of hospital and departmental policies and procedures, and the ability to apply them appropriately. Maintains patient privacy and confidentiality in compliance with HIPAA regulations, ensuring the security of protected health information (PHI).
• Ability to follow oral and written instructions accurately and seek clarification or guidance when necessary.
• Proficiency in Microsoft Office Suite (Word, Excel, Outlook, and PowerPoint).
• Demonstrates accountability by taking responsibility for assigned duties and actions.
• Performs related duties as required or assigned in support of departmental goals.
• Communicates effectively, both verbally and in writing, with clarity, professionalism, and attention to detail.
• Exhibits teamwork and adaptability by maintaining a positive and professional attitude during periods of change or challenging situations.
• Builds and maintains effective working relationships that promote quality customer service; demonstrates courtesy, empathy, and awareness of patient, visitor, and staff needs.
• Works independently and performs well under pressure, prioritizing and managing multiple tasks and deadlines effectively.

All your information will be kept confidential according to EEO guidelines.

COMPENSATION

• Pay Range: $21.50-$30.12
• Other Compensation (if applicable):
• Review the 2025-2026 UMMS Benefits Guide

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