Patient Access Rep Lead – Resource Specialist

Essential Functions

• Manage complex financial clearance cases, including high-dollar procedures, transplant services, and uninsured patients.
• Serve as a mentor and resource for Financial Counselors, Schedulers, Patient Access Medical Necessity Analysts and Patient Access Representatives.
• Conduct in-depth financial assessments and assist patients in navigating insurance coverage, payment options, and financial assistance programs.
• Obtain prior authorizations and document approvals in the registration system as needed.
• Collaborate with clinical departments, case management, and revenue cycle teams to resolve financial barriers to care.
• Lead training sessions and support onboarding of new staff.
• Monitor and report on key performance indicators related to financial counseling activities.
• Ensure compliance with hospital policies, payer requirements, and regulatory standards.
• Maintain accurate and timely documentation in EHR and financial systems.
• Participate in quality improvement initiatives and recommend process enhancements.
• Provide exceptional customer service and maintain patient confidentiality in accordance with HIPAA.

Education

• MINIMUM QUALIFICATIONS: Five (5) years in healthcare financial counseling, patient access, or revenue cycle operations.
• LICENSURE OR CERTIFICATION: None required; CHAA or related certification preferred.

Knowledge, Skills, And Abilities

• Advanced knowledge of healthcare billing, insurance plans, and financial assistance programs.
• Strong leadership and mentoring abilities.
• Excellent communication and interpersonal skills.
• Proficiency in EHR systems, payer portals, and Microsoft Office Suite.
• Ability to manage multiple priorities in a fast-paced environment.
• Strong analytical and problem-solving skills.
• Commitment to patient advocacy and service excellence.