Patient Access Integrity Specialist

Jackson Health System; Miami (FL); Hybrid; USD 60,000 - 85,000; Full time

Job summary

Jackson Health System is seeking a Patient Access Integrity Specialist in a hybrid Miami setting. The role ensures accuracy and regulatory compliance across Patient Access and Revenue Cycle workflows, emphasizing Financial Clearance and Authorization activities.

You will conduct audits, identify trends, and support staff education to reduce denials and improve data integrity. The position requires strong analytical and communication skills, 2–4 years in QA/Audit related to revenue cycle, and a

Qualifications

• Ability to analyze and document audit findings with accuracy.
• Experience in Revenue Cycle QA/Audit or related roles is preferred.
• Strong written and verbal communication skills.

Responsibilities

• Conduct daily audits of Patient Access, Financial Clearance, and Authorization.
• Review audit results and escalate issues to prevent denials.
• Document findings in QA system and maintain logs.
• Analyze trends to identify errors and process gaps.
• Prepare daily/weekly QA summaries and reports for leadership.
• Provide feedback and assist in training and playbook updates.
• Collaborate with IT to refine workflows and audit tools.
• Monitor authorization turnaround times and escalation of delays.
• Support testing of system enhancements affecting QA processes.
• Perform additional duties to support quality and compliance objectives.

Skills

Analytical thinking

Organization

Prioritization

Communication

Problem solving

Attention to detail

Education

High School diploma

Bachelor's degree in related field

Tools

Quality Assurance software

Job description

Location: Jackson Business Cooperate Office; River Landings

Shift: Hybrid; 8:30am- 4:30 pm

Miami, FL Full-Time RCM - Value Alignment Group (VAG)

Summary

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.

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 escalated 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.

Experience

Generally requires 2 to 4 years of experience in Revenue Cycle Quality Assurance/Audit roles

Education

High School diploma is required. Bachelor's degree in related field is strongly preferred.

Skill

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.

Credentials

Valid license or certification is required as needed, based on the job or specialty.

Unit Specific Credential

Working Conditions

Physical Requirements

- Job function is sedentary in nature and requires sitting for extended periods of time. Function may require frequent standing or walking. Must be able to lift or carry objects weighing up to 20 pounds. Jobs in this group are required to have close visual acuity to perform activities such as: extended use of computers, preparing and analyzing data and analytics, and other components of a typical office environment. Additional information and provision requests for reasonable accommodation will be provided by the home unit/department in collaboration with the Reasonable Accommodations Committee (RAC).

Environmental Conditions

- Jobs in this group are required to function in a fast paced environment with occasional high pressure or emergent and stressful situations. Frequent interaction with a diverse population including team members, providers, patients, insurance companies and other members of the public. Function is subject to inside environmental conditions, with occasional outdoor exposures. Possible exposure to various environments such as: communicable diseases, toxic substances, medicinal preparations and other conditions common to a hospital and medical office environment. May wear Personal Protective Equipment (PPE) such as gloves or a mask when exposed to hospital environment outside of office. Reasonable accommodations can be made to enable people with disabilities to perform the described essential functions. Additional information and provision requests for reasonable accommodation will be provided by the home unit/department in collaboration with the Reasonable Accommodations Committee (RAC).