Guest Eligibility Specialist I- Arizona

RI International; Arizona; Hybrid; USD 44,000 - 46,000; Full time

Benefits offered by this job

Health benefits

Retirement plan with company matching

Paid time off

Job summary

RI International is hiring a Guest Eligibility Specialist I to verify insurance coverage, review prior authorizations, and submit requests via payer portals. The role requires accuracy, confidentiality and strong communication with providers and payers.

This is a remote position with MT time zone requirements and a potential transition from temporary to full-time based on performance. The ideal candidate has at least four years of registration/authorization experience and a solid understanding

Qualifications

• High school diploma or equivalent required.
• 4+ years of registration and prior authorization experience.
• Working knowledge of CMS guidelines and coding policies.
• Excellent written and verbal communication with providers and payers.
• Ability to maintain confidentiality under HIPAA.

Responsibilities

• Verify insurance coverage and eligibility.
• Review CPT, HCPCS, ICD-10 codes to determine prior authorization.
• Submit authorizations via payer portals and follow up.
• Maintain accurate patient records and documentation.
• Communicate with departments and payers on project status.
• Identify trends in payer issues and report to Revenue Cycle Manager.

Skills

Insurance verification

HIPAA compliance

Communication skills

CMS guidelines knowledge

Payer portals proficiency

Education

High school diploma or equivalent

Tools

Microsoft Excel

Payer portals

Job description

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 I

Job Type:

Full-Time / Non-Exempt This is a temporary-to-permanent assignment for up to 12 weeks. Upon completion of the assignment, the opportunity to transition to a full-time position will be based on performance and business needs at that time.

Shift Details:

Tuesday, Wednesday, Thursday, Friday, Saturday 10:00 AM-6:30 PM. Training Schedule: For the first three weeks of employment, all training will take place Monday through Friday from 8:00 AM–4:30 PM. New hires are required to attend and complete all three (3) days of New Employee Celebration (NEC), and full attendance for all three days is mandatory. Upon successful completion of the three-week training period, the employee will transition to their regular Tuesday through Saturday, 10:00 AM–6:30 PM schedule.

Work Location:

Crisis - Remote; Must Reside In Mountain Standard Time; Arizona Preferred.

Salary/Hourly Wage:

$21.00 - $22.00/hour

Specialties / Licenses or Certifications:

-Knowledge of Mercy Care, Court ordered Evaluations (COE), Release of Evaluation (ROE)

Summary of the Job:

The Guest Eligibility Specialist I 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 I 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.
• 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.
• 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.

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.

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.

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.