Patient Services Specialist - Referrals

Position Description

This position is responsible for ensuring the smooth operation of the clinic patient flow and serving as the primary contact for patients. Responsible for scheduling appointments, preparing necessary paperwork before the patient visits, receiving patients, and maintaining records. In addition, this position is responsible for processing charges for clinic services, filing insurance claims, responding to requests for information from patients and insurance companies and maintaining related information for the department. Employees may have cash-handling responsibilities.

Department

Pediatrics Ama Genl

Major/Essential Functions

• Coordinates and processes incoming and outgoing referrals for Pediatric General Pediatrics and Pediatric Specialty clinics in a timely and accurate manner.
• Reviews referrals for completeness, verifies required clinical documentation, and obtains additional information as needed to facilitate timely patient scheduling.
• Serves as the primary liaison between TTUHSC Pediatrics, referring providers, specialty practices, hospitals, insurance companies, and patients/families regarding referral status.
• Utilizes the electronic medical record (EMR) and referral tracking systems to accurately document referral activity, monitor referral status, and ensure timely follow-up through completion.
• Tracks referral milestones including receipt, processing, scheduling, appointment completion, and communication back to referring providers when appropriate.
• Coordinates with the Eligibility/Authorization Specialist to ensure referrals requiring insurance authorization are processed efficiently prior to scheduled appointments.
• Assists patients and families in navigating the referral process while providing exceptional customer service and maintaining patient confidentiality.
• Communicates professionally with providers, nurses, clinic staff, and external healthcare organizations to resolve referral-related issues and remove barriers to patient care.
• Identifies referral delays, incomplete documentation, or workflow concerns and escalates issues through established departmental processes.
• Maintains knowledge of payer requirements, referral guidelines, and departmental scheduling protocols.
• Participates in continuous process improvement initiatives designed to improve referral turnaround times, patient access, and operational efficiency.
• Demonstrates proficiency with electronic medical records, referral management tools, Microsoft Office applications, and other software necessary to perform assigned duties.
• Performs additional duties as assigned in support of departmental operations.

Required Qualifications

A High School diploma or GED. 1-year Customer Service, office, or related experience. Additional education may substitute for the experience requirement.

Preferred Qualifications

• Experience in a fast-paced healthcare environment.
• Knowledge of medical terminology and healthcare insurance processes preferred.
• Experience with electronic medical records and referral management systems preferred.

EEO Statement

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.

Jeanne Clery Act

The Jeanne Clery Disclosure of Campus Security Policy and Campus Crime Statistics Act is a federal statute requiring colleges and universities participating in federal financial aid programs to maintain and disclose campus crime statistics and security information. By October 1 of each year, institutions must publish and distribute their Annual Campus Security Policy & Crime Statistics Report (ASR) to current and prospective students and employees. To view this report, visit the TTUHSC Clery Act website at https://www.ttuhsc.edu/compliance/clery-report.aspx.