Patient Services Specialist IV

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.

• 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.

• 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.

• 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