Patient Services Specialist

Health Insurance Specialist

The Health Insurance Specialist plays a critical role in ensuring financial stability and operational efficiency by proactively managing insurance verification, authorization processes, and denial mitigation. This position directly supports timely revenue cycle operations and enhances the patient experience through accurate financial transparency and service excellence.

Insurance Verification & Eligibility Management

Ensure 48-hour compliance for insurance eligibility verification and maintain real-time dashboards for re-verification and insurance changes.

Support same-day verification for clinic care models and add-on scheduling to ensure coverage is confirmed prior to patient arrival or treatment.

Demonstrate proficiency in payer portals and maintain expert-level knowledge of insurance guidelines, including network status, therapy coverage rules, and Medicaid-specific regulations.

Accurately identify patient financial responsibility to reduce days in Accounts Receivable (AR) and improve upfront collections.

Financial Accuracy & Patient Responsibility

Perform financial functions with precision, including copay collection and payment agreement creation under the No Surprise Act.

Assign discount templates in accordance with GSPP guidelines to ensure equitable and compliant billing practices.

Educate patients on financial obligations and assist in establishing private pay arrangements when necessary.

Authorization Management

Manage the full authorization lifecycle—from submission to follow-up—ensuring timely approvals and accurate EMR documentation to prevent overutilization.

Maintain and monitor authorization dashboards to ensure compliance and timely intervention.

Denial Prevention & Resolution

Investigate and resolve insurance denials promptly, identifying root causes and implementing corrective actions to prevent recurrence.

Collaborate with the Utilization Coordinator to analyze denial trends, submit appeals, and report findings for continuous process improvement.

Achieve and maintain key performance indicators: denial rate below 5% and First Pass Resolution Rate of 95%.

Operational Excellence & Patient Experience

Maintain assigned worklists to ensure patient records remain compliant and up-to-date.

Deliver exceptional patient service through effective communication, service recovery techniques, and a positive demeanor.

Lead or contribute to quality improvement initiatives that enhance operational workflows and patient satisfaction.

Maintain a clean and organized work environment, including waiting areas, to support a welcoming atmosphere.

Administrative Support

Greet and direct visitors professionally, ensuring a smooth and respectful experience.

Assist patients in completing necessary documentation, including intake and insurance forms.

Schedule, confirm, and manage patient appointments with accuracy and efficiency.

Handle confidential medical records and correspondence with discretion and compliance.

Manage inbound communications (calls, emails, faxes) and route appropriately to ensure timely response and resolution.

Essential Functions

Patient/Customer

Essential Accountabilities

Ensures communication and collaboration with supervisors and fellow co-workers to serve patients and other customers to the best of his/her ability.

Is professional in all actions and appearance

Ensure compliance with regulatory parameters

Uses resources wisely – as if they were one's own.

Demonstrates understanding and ownership of how his/her role contributes to achieving the success of the Department and the Health System.

Demonstrates a personal commitment to ensuring a clean and safe working environment.

Anticipates patients'/customers' needs and acts accordingly.

Works to enhance patient satisfaction

Assist patients and families

Analyzes problems from the customers' point of view.

Honors patient/customer/employee confidentiality.

Seeks feedback on how to improve performance and offers constructive feedback, as well.

Applies learning for improved performance.

Presents self professionally & demonstrates professional behavior during interactions with others

Strives to understand and value differences in others' race, nationality, gender, age, background, experience, and style.

Customer Service Skills

Utilizes AIDET principles to enhance communication.

Patient/Employee Safety Accountabilities

Patient Care Providers

Participates in Entity and Department wide initiatives for Patient /Employee safety

Demonstrates an awareness of patient/ employee safety when carrying out daily responsibilities of their position.

Validation of annual competencies required for the position

Operations

Essential Accountabilities

Scheduling Functions

Patient Identification

Pre-Reg/Registration-Patient Information Updates

Check-in Process

Check-out Process

Cash Collection

Reconciliation and deposit.

Insurance Verification Process

Email

Management of Medical Records

Financial Counselor

Department Productivity and goals (site specific)

Site Opening Function

Site Closing Function

Ability to Multi-Task

Understanding Clinical Work Processes

Attendance/Time Management

Involvement in Departmental Meetings

Personal Impact

Health System ID is worn in accordance with GSPP policy

Ensures compliance with all federal and insurance laws

Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education

High School Diploma required

Associate's Degree preferred

Work Experience

3+ years or equivalent as a Patient Service Representative 2

Healthcare related experience required; billing experience preferred

Licenses / Certifications

N/A