Patient Access Rep Lead - Resource Specialist

SUMMARY:

The Patient Access Rep Lead - Resource Specialist serves as a subject matter expert and lead resource within the Patient Access team. This role is responsible for managing complex financial clearance cases, mentoring junior staff, and collaborating with clinical and administrative departments to ensure patients receive timely and accurate financial guidance. The Patient Access Rep Lead - Resource Specialist supports departmental goals through leadership, training, and process improvement initiatives.

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.
• Coordinate 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.
• Performs related duties as assigned.

MINIMUM QUALIFICATIONS

EDUCATION: High school diploma or GED required; associate or bachelor's degree in healthcare, finance, or related field preferred.

EXPERIENCE: 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.