Guest Eligibility Specialist

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!

Guest Eligibility Specialist I

Part-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.

Saturday and Sunday 10:00 AM-4:30 PM. Training

Schedule:

For the first three weeks of employment, all training will take place Monday through Friday from 6:00 PM–10:00 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 schedule they were hired.

Crisis – Remote;
Must Reside In Central Standard Time; NC and LA are preferred.

$21.00 – $22.00/hour

• Will be supporting the registration and authorization process for Louisiana and North Carolina. Experience in these states is preferred.

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.

• 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…