Guest Eligibility Specialist II

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 II

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:Thursday, Friday, Saturday, Sunday, and Monday 2:00 PM-10:30 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 schedule.

Work Location: Crisis - Remote;
Must Reside In Central Standard Time;
North Carolina or Louisiana Residency Preferred.

Salary/Hourly Wage:$24.00 - $25.00/hour

Specialties / Licenses or

Certifications:

• Knowledge of NC Medicaid system, Trillium, Alliance Catchment area and NC Tracks
• Knowledge of Louisiana Medicaid, Gainwell and Carelon

Summary of the Job:The Guest Eligibility Specialist II is responsible for managing the complete front-end eligibility and authorization process with greater independence, efficiency, and technical skill than the Specialist I. This includes verifying and entering guest information, reviewing clinical documentation using HCPCS, CPT, and ICD-10 codes, and initiating, submitting, and following up on authorizations through payer portals or fax. The role emphasizes advanced knowledge of coding, payer requirements, and problem-solving, while also contributing to workflow improvements and training initiatives.

This position is vital to ensuring guest information is processed accurately, efficiently, and in compliance with organizational and regulatory standards.

Essential Duties and Responsibilities:

Registration & Eligibility

• Perform guest registration and authorization functions across multiple states.
• Reconcile insurance coverage discrepancies and ensure demographic accuracy.
• Validate complex eligibility situations, escalating only those requiring management review.
• Apply advanced knowledge of CPT, HCPCS, and ICD-10 coding when determining authorization needs.

Compliance & Continuous Improvement

• Ensure adherence to organizational compliance and payer requirements.
• Stay current with changes in state/federal regulations and payer guidelines.
• Identify trends and analyze payer issues, reporting findings to the Revenue Cycle Manager.
• Contribute to process improvements to enhance efficiency and reduce denials.

Documentation, Communication & Training

• Provide detailed documentation of authorization processes and payer communications.
• Communicate professionally with providers, payers, and internal departments, providing feedback and recommendations.
• Assist with developing SOPs and workflow documentation.
• Participate in training new staff members and mentoring peers.

Authorization Management

• Independently manage prior authorizations, reauthorizations, and corrections.
• Research denial reasons with payers and recommend corrective actions to maximize reimbursement.
• Support appeals processes by submitting corrected authorizations as needed.
• Maintain detailed tracking of pending/resolved authorizations and payer issues.

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…