Patient Services Specialist IV

Position Description The PSS IV works autonomously to lead quality assurance reviews, provides feedback to peers, and collaborates with supervisors on process improvement initiatives that impact clinic patient flow. Serves as a point of contact for escalated registration, billing, insurance authorizations, and/or patient concerns. Can train other PSS team members. Referral Coordination & Authorization Management Coordinate and process incoming and outgoing patient referrals in a timely and accurate manner. Review referral orders for completeness, required clinical documentation, medical necessity, and payer‑specific requirements. Obtain and manage insurance authorizations for specialty services, procedures, and diagnostic testing. Monitor referral and authorization work queues to ensure appropriate follow‑up, status updates, and closure of referrals. Resolve complex or escalated referral, scheduling, insurance, and authorization issues with minimal supervision. Maintain accurate documentation within the electronic medical record (EMR) and scheduling systems. Provider, Clinic & Specialty Communication Serve as a liaison between referring providers, specialty clinics, ancillary departments, and external healthcare offices. Communicate referral status updates, scheduling barriers, authorization delays, and documentation needs to providers and clinical teams. Collaborate with clinic leadership and care teams to support continuity of care and efficient patient flow. Ensure providers receive necessary referral documentation before specialty appointments or procedures. Patient Coordination & Customer Service Communicate with patients regarding referral status, insurance authorization requirements, scheduling updates, and next steps in care. Assist patients with scheduling referred appointments and provide instructions related to specialty visits or required documentation. Address escalated patient concerns professionally and effectively while maintaining patient confidentiality and service excellence. Promote a positive patient experience through timely communication and problem resolution. Quality Assurance & Process Improvement Perform quality assurance reviews of referral and authorization workflows to ensure compliance, accuracy, and operational efficiency. Identify workflow gaps, referral delays, and process improvement opportunities impacting clinic operations and patient access. Collaborate with supervisors and leadership to implement process improvements that enhance referral turnaround times and clinic efficiency. Support compliance with departmental policies, payer guidelines, HIPAA regulations, and organizational standards. Team Support & Training Serve as a resource and mentor for referral coordinators, Patient Service Specialists (PSS), and clinic support staff. Assist with onboarding, cross‑training, and education related to referral workflows, insurance authorization processes, and work queue management. Provide feedback and guidance to peers to promote consistency, accountability, and high‑quality service standards. Occasional Duties Assist with coverage for front‑end clinic operations, scheduling, or registration functions as needed. Participate in departmental meetings, workflow audits, and operational improvement initiatives. Support implementation of new referral processes, software updates, or payer workflow changes. Compile or assist with referral‑related reports, metrics, and tracking data. Perform other duties as assigned to support clinic operations and patient care coordination. Required Qualifications High School diploma or equivalent, and five (5) years of related experience. Preferred Qualifications Associate’s or Bachelor’s degree in healthcare administration, business administration, or related field preferred. Minimum of 3–5 years of experience in healthcare referrals, insurance authorization, scheduling, or patient access operations preferred. Advanced knowledge of medical terminology, insurance plans, prior authorization requirements, and referral management processes. Experience working within an ambulatory or specialty clinic environment preferred. Proficiency with electronic medical record (EMR) systems and referral management work queues. Demonstrated ability to independently resolve complex patient, provider, and insurance‑related issues. Strong organizational, communication, customer service, and multitasking skills. Experience training or mentoring staff preferred. Knowledge of HIPAA, payer compliance standards, and healthcare workflow optimization principles. Benefits Health Plans + Supplemental Coverage Options – Individual health insurance provided at no cost for full‑time team members Paid Time Off – Including holidays, vacation, sick leave and more Retirement Plans Wellness Programs Certified Mother‑Friendly Workplace TTUHSC invests in the success of team members by providing opportunities for personal and professional growth, including lifelong learning programs, recognition programs, and health and wellness initiatives. Team members also enjoy perks such as special membership rates at local gyms and golf courses, access to state‑of‑the‑art software and facilities, and discounts on travel, technology, entertainment and more. Job Details Job Type: Full Time Pay Basis: Hourly Pay Grade Minimum: $20.00 Pay Grade Maximum: $26.00 Pay Statement: Compensation is commensurate upon the qualifications of the individual selected and budgetary guidelines of the hiring department, as well as the institutional pay plan. For additional information, please reference the institutional pay plan website at Grant Funded: No Travel Required: None Shift: Day Schedule: M‑F 8‑5 Research Laboratory: No All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, disability, genetic information or status as a protected veteran. The Jeanne Clery Disclosure of Campus Security Policy and Campus Crime Statistics Act requires colleges and universities participating in federal financial aid programs to maintain and disclose campus crime statistics and security information. To view this report, visit the TTUHSC Clery Act website at #J-18808-Ljbffr