Guest Eligibility Specialist II Louisiana and North Carolina

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

Shift Details: Friday-Monday, 12:00 PM-10:30 PM (four 10-hour shifts per week). Training Requirements: Attendance is required for our three-day New Employee Celebration (orientation) and subsequent training Monday-Friday, 8:00 AM-4:30 PM EST. Upon successful completion of training, employees will transition to their regular Friday-Monday schedule.

Work Location: Crisis - Remote; Must Reside In AZ, DE, FL, LA, MA, MD, MI, NC, OH, OR, PA, TN, TX, UT, or WA

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

Specialties / Licenses or Certifications: Will be supporting North Carolina and Louisiana.

• Must have registration & authorization experience
• Knowledge of NC insurance payors to include: Alliance, Trillium, Vaya
• Experience running eligibility on portals like: Availity, Navinet, and NC Tracks

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 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.

Education/Licenses

• High school diploma or equivalent
• Must have a valid driver license and be 18 years of age

Experience

• 4+ years of registration and authorization experience required
• Working knowledge of CMS guidelines, contracted insurance guidelines, and coding policies

Skills

• Organized and detail-oriented
• Excellent time management skills
• Reliable and able to multi-task in a fast-paced, high-volume work environment
• Intermediate to advanced proficiency in Microsoft Excel
• Ability to maintain a high level of confidentiality in compliance with HIPAA guidelines and regulations
• Professional communication and interpersonal skills

Driving Requirements

• Must be able to pass a three-year motor vehicle report and meet minimum eligibility requirements of insurance carrier (if driving is required for this position)

Miscellaneous Requirement(s):

• Travel required based on business need.
• Must be at least 18 years old unless residing in a state where funder or government regulations set a different minimum age requirement.
• 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 obtain designated fingerprinting clearance in applicable states.
• 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.

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.