Guest Eligibility Specialist II
Key Skills for This Role
Full Job Posting
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.
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)
- 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).
- 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).
- 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.
About Recovery Innovations
Provides behavioral health crisis and recovery services.
Visit company websiteJobs and hiring trendsApply for this job in 1 click
Skip the repetitive application forms
Install the Base Career Chrome Extension and autofill job applications across major job boards with your profile.
Trusted by over 500,000 job seekers on Base Career
More from this employer
More jobs at Recovery Innovations
SOAR Benefits Specialist
Durham, USA
Licensed Practical Nurse
Fayetteville, USA
Registered Nurse
Durham, USA
Revenue Cycle Specialist I
, USA
Constable
, USA
Clinician II
Columbus, USA
Peer Support Specialist I
, USA
Guest Eligibility Specialist I
, USA