Patient Services Specialist

About the role

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.

Responsibilities

• 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.
• Patient/Customer Accountabilities
  • Ensure communication and collaboration with supervisors and fellow co-workers to serve patients and other customers to the best of their ability.
  • Act professionally in all actions and appearance.
  • Ensure compliance with regulatory parameters.
  • Use resources wisely and demonstrate understanding and ownership of how the role contributes to the success of the Department and the Health System.
  • Demonstrate a personal commitment to ensuring a clean and safe working environment.
  • Anticipate patients’/customers’ needs and act accordingly to enhance patient satisfaction.
  • Analyze problems from the customers’ point of view.
  • Honor patient/customer/employee confidentiality.
  • Seek feedback on how to improve performance and offer constructive feedback.
  • Apply learning for improved performance.
  • Present self professionally and demonstrate professional behavior during interactions with others.
  • Strive to understand and value differences in others’ race, nationality, gender, age, background, experience, and style.
  • Utilize AIDET principles to enhance communication.
• Patient/Employee Safety Accountabilities
  • Participate in Entity and Department-wide initiatives for Patient/Employee safety.
  • Demonstrate an awareness of patient/employee safety when carrying out daily responsibilities.
  • Validate annual competencies required for the position.
• Operational Accountabilities
  • Perform scheduling functions, patient identification, pre-registration/registration updates, check-in/check-out processes, and cash collection reconciliation and deposit.
  • Manage insurance verification processes, email, medical records, and financial counseling.
  • Ensure department productivity and goal achievement (site-specific).
  • Handle site opening and closing functions.
  • Demonstrate ability to multi-task and understand clinical work processes.
  • Maintain attendance/time management and involvement in departmental meetings.
  • Wear Health System ID in accordance with GSPP policy.
  • Ensure compliance with all federal and insurance laws.

Requirements

• High School Diploma required; Associate's Degree preferred.
• 3+ years or equivalent as a Patient Service Representative.
• Healthcare-related experience required; billing experience preferred.

Benefits

• Health Insurance
• Family Forming Benefits (Fertility, Surrogacy, Adoption)
• Wellbeing Program
• Rx Insurance
• Dental Insurance
• Vision Insurance
• Pre-Tax Spending and Savings Accounts
• Short Term Disability
• Long Term Disability
• Employer Paid Life Insurance
• Employer Paid AD&D Insurance
• 403(b)
• Employee Assistance Program
• Tuition Reimbursement
• Student Loan/PSLF Management Services
• Supplemental Income Protection Insurances (Hospital Indemnity, Critical Illness, Accidental Injury, Cancer Advocate Plus)
• Continuing Education
• Paid Time Off (PTO)
• Extended Sick Bank (ESB)
• Bereavement Leave
• Jury Duty Leave
• Employee Discount Program