Centralized QA, Patient Services Specialist II

EDUCATION & EXPERIENCE

Minimum Qualifications:

• Associate degree and one year of clerical or customer service experience. An equivalent combination of education and experience relevant to the role may be considered for this position

Centralized QA Patient Services Specialist II — Responsibilities

• Conduct call, documentation, and workflow quality evaluations across all Access Services service lines using standardized QA scoring tools
• Identify performance trends and escalate quality, compliance, or training concerns to appropriate leadership channels
• Document results, scoring rationale, and coaching opportunities with clear, concise, and actionable written feedback
• Participate in calibration sessions to maintain scoring consistency across the QA team and training leadership
• Assist with auditing process improvements, scripting enhancements, and optimization of frontline workflows

JOB SUMMARY

The Patient Services Specialist II has advanced Patient Services Specialist skills and is proficient in independently maintaining a positive patient experience by consistently exceeding expectations in customer service and patient care, by coordinating clerical and medical activities of a healthcare team, patient registration activities and facilitating access to UTMB services for new and returning patients.

ESSENTIAL JOB FUNCTIONS

LEAD RESPONSIBILITES:

• Ability to function as a team leader.
• Provides peer guidance and leadership.
• Able to effectively triage problems.
• Understand clinic flow to maximize clinic usage to meet patient needs.

CUSTOMER SERVICE:

• Provides high level customer service in all interactions with internal and external customers.
• Provides direct, professional, and knowledgeable interactions with patients, physicians, referral sources, and the treatment team.
• Answers always call accurately and with exceptional customer service.
• Ensures caller's needs are met and accurate information is obtained.
• Ensures calls are documented and triaged appropriately ensuring patient satisfaction and patient safety. Completes telephone encounter process if appropriate.
• Acts as patient advocates and liaisons with various departments to meet mutual goals.
• Maintains patient confidentiality regarding access to patient and other clinical information via email, computer, fax and mail.
• Addresses concerns of patients, provides service recovery, and escalate issues as needed.

SCHEDULING:

• Applies the policies of the clinical entity to schedule appointments.
• Coordinates financial counseling for day surgery.
• Completes reminder calls to patients for scheduled appointments.
• Educates patient/responsible parties regarding billing process and any additional financial responsibilities including third party benefits information.
• Provides out of pocket cost estimates to patients.
• Counsels patients about unpaid bills.

JOB DESCRIPTION

• Obtains future appointments at time of service for clinic follow-up, referrals, and ancillary services.
• Arrives patients and prepares paperwork/chart for visit.
• Appropriately receipts all monies collected, tokens distributed, and deferments authorized.
• Verifies, ensures eligibility, and pre-registers patients by obtaining patient demographics and third-party coverage(s) at every encounter.
• Obtains and documents required for third party reimbursement.
• Ensures compliance with Medicare and third-party coverage.
• Communicates with patients, referral source, UTMB physician and clinical staff regarding any obstacles to access or authorization.
• Fully dispositions each patient within the designated timeline.

Marginal or Periodic Functions:

• Performs related duties as required.
• Adheres to internal controls established for department.
• Reads all OSA Announcements and relevant communications relating to job duties.
• Successfully completes competency-based training and testing on an annual basis.
• Prioritizes and completes all work in an accurate, effective, and efficient manner.
• Locks office and secures files containing money or confidential information when away from workstation.
• Properly disposes of printed patient information, logs off computer when leaving workstation and keeps passwords confidential.
• Participates in team meetings/activities and supports the philosophy and goals of the team/department.

KNOWLEDGE/SKILLS/ABILITIES

Assist the individual in successfully performing the role

• Proficient in use of PC with experience in Excel, Word, and database management packages.
• Analytical and ability to collect and trend data.
• Knowledge of patient care and patient problems.
• Excellent human relations and written and oral communication skills.
• Ability to solve problems.

Salary Range:

Actual salary commensurate with experience or range if discussed and approved by hiring authorities.

Work Schedule:

On-site, Monday through Friday, 8am to 5pm, and as needed on occasion.

Equal Employment Opportunity

UTMB Health strives to provide equal opportunity employment without regard to race, color, religion, age, national origin, sex, gender, sexual orientation, gender identity/expression, genetic information, disability, veteran status, or any other basis protected by institutional policy or by federal, state or local laws unless such distinction is required by law. As a Federal Contractor, UTMB Health takes affirmative action to hire and advance protected veterans and individuals with disabilities.