Member Financial Specialist – Eligibility & COB

Groups Recover Together, Inc.•Remote,

2d•$19 - $25•Remote

About The Position

As a Member Financial Specialist – Eligibility & COB Focus, you will play a vital role in resolving Coordination of Benefits (COB) denials, addressing complex eligibility and coverage issues, and ensuring accurate and timely updates to member accounts. You will work closely with members and insurance carriers to resolve discrepancies, educate members about their benefits, and support initiatives that promote clean claims and reduce financial barriers to care. The Member Financial Support function ensures that patients have a clear and consistent understanding of their financial responsibilities, supports accurate claims processing from the start of care, enforces transparent payment policies, and helps make care affordable and accessible to all. You will also contribute to the organization’s mission and values by bringing a strong sense of purpose, empathy, and teamwork to every interaction and workflow.

Requirements

Mission-driven: You are deeply invested in patient success and committed to advancing the organization’s mission
Strong communicator and culture-bearer: You represent the organization’s values in every member interaction and communicate clearly, confidently, and with cultural sensitivity
Adaptable in fast-paced environments: You thrive in dynamic settings and can respond quickly to member needs
Collaborative: You excel at building strong relationships across teams and working toward shared goals
Data-savvy: You enjoy using data to evaluate performance and inform decision-making
Innovative thinker: You can challenge the status quo and propose creative, practical solutions
Highly organized: You manage multiple priorities and moving pieces with precision and consistency
Flexible and resourceful: You navigate ambiguity and rapid change with ease and professionalism
Self-directed: You are comfortable working independently and exercising sound judgment
Comfortable operating an EMR, RCM and Microsoft Office/Google Products
Able to use video conferencing platforms and ticketing systems
Able to operate effectively in a remote environment
Quick learner: Able to rapidly understand new insurance plans, payer processes, and internal tools
Professional discretion: You handle sensitive information responsibly and ethically
Compliance: Understand and adhere to the organization’s Code of Conduct
Bachelor’s degree or equivalent combination of education and experience required
Minimum of 2 years of direct patient-facing experience in patient access, financial counseling, or utilization management
Experience in SUD/Behavioral Health strongly preferred
Prior experience speaking with SUD/Behavioral Health patients about coverage, benefits, and patient responsibility
Familiarity with working via telehealth
Comfortable communicating directly with payers and navigating insurance organizations
Strong working knowledge of commercial, Medicare, and Medicaid behavioral health/SUD plans
Experience in a high-growth, dynamic environment is strongly preferred
Access to reliable internet and phone services (minimum 40 Mbps download / 10 Mbps upload with strong Wi-Fi signal at remote location)
Must meet all pre-employment requirements, which may include fingerprinting, drug testing, health screenings, and background checks based on state-specific guidelines

Nice To Haves

Experience with Apero is a plus

Responsibilities

Investigate and resolve COB denials by communicating directly with insurance carriers and members
Conduct outreach to members to gather and update insurance details, verify coverage, and provide education on next steps
Support special projects related to eligibility changes, contract updates, and coverage transitions
Accurately update member accounts with verified insurance data, and notify members of any changes in benefits or financial responsibilities
Perform routine and ad-hoc reporting to identify trends in COB denials, eligibility issues, and coverage discrepancies
Run, interpret, and act on data reports to support operational improvements and targeted outreach
Communicate professionally with members and insurance companies via phone, video, and written correspondence
Review and process documents related to coverage updates, COB forms, and payer communications
Maintain a strong understanding of insurance policies, benefits structures, and patient responsibility guidelines
Perform other duties as assigned as the role and company evolve