Patient Services Specialist | Primary Care | Flormann St Clinic

About the role

The Patient Services Specialist ensures timely and accurate patient access to medical services by managing prearrival prior authorization services. This role validates insurance eligibility, verifies plan benefits, and completes financial clearance, prior authorization, and pre‑determination processes so that scheduled medical services and referrals are financially cleared before the date of service. The position is located in Rapid City, SD, within the MHMC‑RC Flormann St. Primary Care department, requires 40 scheduled weekly hours, and is a regular employee type. Job Category: Patient Services; Job Family: Patient Support.

Responsibilities

• Collaborate with healthcare providers, clinical staff, and various departments throughout Monument Health as well as with the patient to secure necessary authorization for services while maintaining compliance with all regulatory requirements.
• Accurately verify patient insurance eligibility and benefits coverage using Electronic Health Records (EHR), add‑on software, direct payer websites, and telephone or fax communications to ensure accurate reimbursement and compliance.
• Assess service requests to determine the need for pre‑certification, pre‑authorization (procedure or medication), or referrals, and communicate effectively with relevant stakeholders to secure approvals prior to the date of scheduled services.
• Maintain a strong working knowledge of various insurance payers, payer plans, and program contract requirements to facilitate appropriate insurance verification and authorization processes.
• Continuously meet competency requirements to sustain the necessary skills, knowledge, and abilities for role‑specific functions while adhering to productivity and quality performance standards.
• Create a positive service experience by being polite, compassionate, and professional with all internal and external customers.
• Document pre‑authorization information accurately in the EHR system, ensuring that services scheduled by internal and external providers meet all financial clearance criteria and have approved authorization within the time allowed by payers and programs to prevent denial or penalty assessment.
• Engage with departments and clinical staff to communicate the need for pre‑authorizations or referrals promptly, working to prevent delays in patient care; may include assistance with managing appeals and coordinating peer‑to‑peer reviews when needed.
• Identify high‑risk requests that may require financial assistance and counseling, and assist patients by providing guidance on available resources, financial assistance, or payment arrangements.
• Advocate for patients and providers by addressing challenges related to pre‑authorization approvals and denials, working closely with leadership to resolve issues and ensure compliance with financial clearance policies.
• Provide backup support for Patient Admissions and Registration as needed.
• Confirm prescription coverage and coordinate prior authorization, including collecting and submitting required clinical documentation (provider notes, labs, treatment history).
• Stay up to date on patient assistance programs and guide patients through required application documentation.
• Coordinate with providers and nursing staff to obtain required signatures and documentation from patients and providers.
• Serve as a patient advocate by regularly communicating with pharmaceutical companies, providers, and patients.
• Act as primary contact for patient inquiries about medication authorizations and assistance programs.
• Monitor assistance medications to ensure timely delivery and continuous patient access.
• All other duties as assigned.

Requirements

• Education: High School Diploma/GED Equivalent in General Studies (required).
• Preferred Experience: 1+ years in Health Care Services, Customer Service, Patient Scheduling, or Patient Billing.
• Preferred Education: Associates degree in a Healthcare Related Field.
• Physical Requirements: Sedentary work – exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body; involves sitting most of the time.

Benefits

• Supportive work culture
• Medical, Vision and Dental Coverage
• Retirement Plans, Health Savings Account, and Flexible Spending Account
• Instant pay available for qualifying positions
• Paid Time Off Accrual Bank
• Opportunities for growth and advancement
• Tuition assistance/reimbursement
• Excellent pay differentials on qualifying positions
• Flexible scheduling

Pay

Starting Pay Rate Range: $18.27 - $21.00 (determined by the knowledge, skills, and experience of the applicant).

Schedule

Scheduled Weekly Hours: 40. Shift requires the ability to work assigned schedules and hours as determined by the