Patient Services Specialist IV

Job Description:

Patient Services Specialist IV

Description

Patient Services Specialist IV
Lubbock
44851BR

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.

Major/Essential Functions
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.

Required Qualifications
High School diploma or equivalent, and five (5) years of related experience.

To apply, please visit: https://sjobs.brassring.com/TGnewUI/Search/home/HomeWithPreLoad?partnerid=25898&siteid=5283&PageType=JobDetails&jobid=914275

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.

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