Guest Eligibility Specialist

RI International; United States; Remote; USD 60,000 - 80,000; Full time

Job summary

RI International is seeking a Guest Eligibility Specialist to join their mission of empowering individuals in their recovery journey. This remote position involves verifying insurance eligibility, handling authorizations, and ensuring accurate data entry. Ideal candidates will have strong organizational and communication skills with a background in registration and insurance processes.

Benefits

Competitive health, dental, and vision insurance

Access to mental health resources

Comprehensive benefits package

Qualifications

• 4+ years of registration and authorization experience required.
• Working knowledge of CMS guidelines and coding policies.
• Ability to maintain confidentiality (HIPAA guidelines).

Responsibilities

• Verify insurance coverage and eligibility.
• Review procedure orders for prior authorization necessity.
• Document authorization numbers and maintain medical records.

Skills

Organizational skills

Communication skills

Analysis

Attention to detail

Education

High school diploma or equivalent

Tools

Microsoft Excel

Job description

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Join to apply for the Guest Eligibility Specialist role at RI International

This range is provided by RI International. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

Base pay range

$21.00/hr - $21.00/hr

Change Lives With Recovery Innovations! Our Mission is to empower people on their journey to recovery, helping them achieve their goals, rediscover meaning and purpose in life, and reconnect with themselves and their communities. Our Vision is to revolutionize healthcare by pioneering innovative solutions that go beyond behavioral health, empowering people to thrive in the communities where they live, work, and play. Join a groundbreaking team at the forefront of Peer-Powered Support, empowering individuals on their journey through mental health and substance use challenges! Be part of something bigger—together, we can change lives and create lasting hope!

Position: Guest Eligibility Specialist

Job Type: Pool / Non-Exempt

Shift Details: Saturday, Sunday and 1 evening during the week - 12 - 14 hours weekly

Work Location: Remote

Salary/Hourly Wage: $21.00/hour

Specialties / Licenses or Certifications:

• The position will support the registration and authorizations process for Arizona
• Experience with MercyCare RHBA
• Coordination of Benefits
• Court Ordered Enforcement.
• Registration
• Authorizations
• Insurance portal
  
  
  

Summary of the Job: The Guest Eligibility Specialist position is responsible for ensuring all required information is accurately collected and entered into the system. By reviewing clinical documentation per HCPCS, CPT, and ICD-10 codes, initiating, submitting, and follow up on authorizations per payer portals, and faxing requests the Guest Eligibility Specialist is involved in the complete front-end process. They ensure all required information is accurately collected and entered into the system. This is a vital role for Recovery Innovations to ensure guest information is processed effectively and efficiently.

Essential Duties and Responsibilities:

• Verify insurance coverage and eligibility.
• Knowledge of CPT, HCPCS, and ICD-10 codes.
• Review procedure orders and documentation to determine necessity of prior authorization.
• Provide feedback to departments, sites, and payers on project status.
• Strong written and communication skills with providers, team members and clients.
• Detailed documentation of authorization numbers and process for each prior authorization.
• Maintain accurate patient medical records.
• Make status calls to insurance companies and utilize payer portals to follow on submitted authorization for reimbursement.
• Identify, analyze, report on trends and analysis of all payer issues and report it to the Revenue Cycle Manager.
• Research authorization denial reasons per payers or by contacting the funders to maximize claim reimbursement.
• Follow company processes related to submission of corrected authorizations and appeals.
• Maintain tracking sheet of pending/resolved issues and historical payer issues.
• Validates demographic/insurance information entered in system by staff is accurate and completed on a timely basis.
• Reconciles eligibility/insurance coverage discrepancies.
• Verify and identify guest insurance information through state portals.
• Responsible for completing guest financial eligibility.
• Understands and adheres to Recovery Innovations compliance standards as they appear in the Code of Conduct and Conflict of Interest Policies.
• Keeps abreast of all federal and state regulations and laws and all Recovery Innovations policies as they presently exist and as they change or are modified.
• Performs other related duties assigned.
  
  
  

Your well-being and success are our priority at RI—explore our benefits and discover how we invest in YOU every step of the way! As an innovative leader in behavioral health care, we are committed to supporting our teams through a comprehensive benefits package. This includes competitive health, dental, and vision insurance, as well as access to mental health resources and wellness programs. We offer a strong retirement plan with company matching and generous paid time off to support work-life balance. In addition, we provide ongoing opportunities for professional development and training to help you advance in your career. We value the contributions of our team members and are dedicated to fostering a supportive, inclusive environment where you can thrive both personally and professionally.

Job Requirements: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed must be representative of the knowledge, skills, minimum education, training, licensure, experience, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties.

• Organized and detail oriented.
• Excellent time management skills
• High school diploma or equivalent.
• 4+ years of registration and authorization experience required.
• Working knowledge of CMS guidelines, contracted insurance guidelines and coding policies.
• Detailed oriented, reliable, and able to multi-task in a fast-paced, high-volume work environment.
• Intermediate to Advanced proficiency in Microsoft Excel.
• Must have a valid driver license and be 18 years of age.
• Ability to maintain a high level of confidentiality (HIPAA guidelines and regulations) and professionalism.
• We are a Second-Chance Employer
• Must be able to pass a seven-year background check.
• Must be able to pass substance abuse testing and/or tuberculous testing (if applicable).
• Must be able to pass education verification check.
• Must be able to pass three-year motor vehicle report and meet minimum eligibility requirements criteria of insurance carrier (if driving is required for this position).
  

Driving Requirements:

• If driving is required for this position, must meet all requirements outlined in Recovery Innovations driving policy.
• If not qualified to drive per driving policy, a Non-Driver Attestation form must be signed.
  
  
  

Physical Demands:

May include work close to the eyes and substantial motions of the wrist, hands, and/or fingers. Frequent sitting, standing, walking, handling, finger dexterity; eye-hand-foot coordination, use of corrected vision; color vision; use of auditory senses. May be required to lift up to twenty (20) pounds.

Work Environment

May work in an office environment or behavioral health facility. May have contact with individuals who are agitated and/or confused.

Recovery Innovations is committed to providing equal employment opportunities to all individuals. Our hiring practices are based on merit, qualifications, and abilities. We do not discriminate against any employee or applicant on the basis of race, color, religion, sex, national origin, age, disability, veteran status, or any other characteristic protected by law. We strive to create a workplace where every employee feels valued and respected.

Recovery Innovations is a second chance employer, and we evaluate all qualified applicants fairly, including those with criminal histories, in accordance with legal and funder requirements. If you need assistance and/or reasonable accommodation due to a disability during the application or the recruiting process, please send a request via the Accommodation request form.

Benefits/perks listed above may vary depending on the nature of your employment with Recovery Innovations.

The wage range for this role considers the wide range of factors that are considered in making compensation decisions including but not limited to skill sets; experience and training; licensure and certifications; and other business and organizational needs. The disclosed range estimate has not been adjusted for any applicable geographic differential associated with the location at which the position may be filled. At Recovery Innovations compensation decisions are dependent on the facts and circumstances of each case.

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Other

• Industries

  Mental Health Care

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