Insurance Verification Specialist Jobs in Riverside, CA

POSITION SUMMARY:

The Behavioral Health Intake Specialist is the first point of contact for individuals, families, and referral partners seeking mental health services through SCCS. This is a high-accountability, revenue-generating role that operates across two distinct intake systems: county Medi-Cal (behavioral health contracts with San Bernardino and Orange Counties) and managed care/commercial insurance. The goal of every contact is a scheduled first appointment. Performance is measured on conversion rate, call quality, and documentation accuracy.

JOB DUTIES & RESPONSIBILITIES:

Intake and Conversion

• Answer all inbound calls from individuals, families, school district partners, hospital discharge planners, county case managers, and payer representatives seeking SCCS services across San Bernardino and Orange Counties. Follow up on all faxes and emails regarding referrals to our county Medi-Cal programs.
• Conduct a standardized needs screen on every contact to determine program fit, payer eligibility, geographic coverage, and level-of-care alignment within SCCS’s program continuum.
• Schedule every eligible caller for an assessment before ending the call. Callers with Medi-Cal are scheduled directly; managed care and commercial insurance callers are scheduled once eligibility and any prior authorization requirements are confirmed.
• Correctly represent SCCS’s full program matrix, payer acceptance, and geographic service area on every call. Coverage and authorization information should only be communicated once it has been verified during that contact.

Insurance Verification

• County Medi-Cal: Confirm eligibility via MEDS or county-designated verification tools. Determine whether the caller falls under a county behavioral health plan contract (San Bernardino or Orange County, for specialty mental health services) or a managed care plan (for mild-to-moderate conditions). Apply Short-Doyle/Medi-Cal documentation protocols and county-designated timely access standards.
• Managed care and commercial insurance: Verify benefits in real time via payer portals or direct payer contact. Confirm SCCS is in-network for the caller’s specific plan type and service category. Determine deductible status, co-pay, out-of-pocket maximum, and visit limits. Identify prior authorization (PA) requirements and initiate or hand off the PA process before scheduling. Document all verified benefit information in MyEvolve/EHR at time of call. For EAP callers, confirm session authorization and employer plan parameters before scheduling.

Scheduling and Coordination

• Book first appointments before the call ends. Confirm appointment details with the caller, including telehealth instructions, required documentation, and any intake paperwork to be completed before the first visit. Track scheduled appointments and follow up on no-shows per SCCS protocol.
• Handle calls from hospital discharge planners, county case managers, school district administrators, care coordinators, and payer representatives with the same accuracy and responsiveness as direct client calls. Provide referral partners with timely confirmation of intake receipt, next steps, and any documentation requirements. Escalate referral partner concerns to the Manager of Intake Operations.

Crisis Escalation

• Identify and escalate calls involving suicidal ideation, homicidal ideation, acute psychiatric crisis, or other safety presentations to licensed clinical staff in real time, following SCCS’s crisis warm handoff protocol. Apply structured de-escalation techniques for distressed callers who do not meet clinical crisis criteria. Document all crisis contacts in MyEvolve/EHR at the time of the call.

Documentation and Compliance

• Enter accurate, complete intake records in MyEvolve/EHR at the time of each contact, including referral source, program assignment, payer and plan information, eligibility and authorization status, appointment details, and all follow-up actions. Support data integrity for payer audits, DHCS reporting, and internal performance monitoring. Maintain compliance with HIPAA across all contact channels.

Performance Standards

• Target referral-to-conversion rate of 65–85%, dependent on program. All calls are monitored; call quality, first-call resolution, and documentation accuracy are reviewed monthly. Accuracy of program and coverage information is a primary quality standard. Participate in call review sessions, apply coaching feedback, and engage in workflow improvement initiatives as directed.
• Performs other related duties as required and assigned.

GENERAL REQUIREMENTS

Education/Experience

1. Associate’s degree or higher in psychology, social work, healthcare administration, public health, or a related field. Equivalent work experience in behavioral health intake, patient access, or healthcare operations will be considered.
2. Minimum two years of experience in behavioral health, healthcare, or social services in a direct client-contact or insurance operations role.

Required Knowledge and Skills

• Working knowledge of Medi-Cal, including county behavioral health plan coverage (San Bernardino and Orange Counties) and managed care plan coverage, as well as commercial.
• Experience verifying insurance benefits in real time using payer portals (Availity, Navinet, or equivalent); working knowledge of prior authorization (PA), eligibility versus authorization, and EAP plan structures.
• Proficiency in Microsoft Office and EHR systems (MyEvolve preferred); ability to manage multiple systems simultaneously during live calls.
• Clear, professional telephone manner; active listening and de-escalation skills; ability to convey complex program and insurance information in plain language to callers who may be in distress.
• Must have strong writing and communication skills.
• Ability to drive a personal or company car on freeways as required for meetings.
• Working knowledge of HIPAA confidentiality requirements and awareness of 42 CFR Part 2 privacy protections applicable to behavioral health settings. Completion of organizational HIPAA training required within 30 days of hire.
• Demonstrated commitment to culturally responsive communication across a diverse service population.

Preferred Qualifications

• Prior experience in behavioral health intake, patient access, admissions coordination, or a managed care call center, with exposure to both county and commercial workflows.
• English and Spanish bilingual fluency strongly preferred and weighted heavily in hiring decisions given SCCS’s service population in San Bernardino and Orange Counties.
• Crisis intervention certification (Mental Health First Aid, ASIST, or equivalent) preferred; required within 90 days of hire.
• Familiarity with county-funded behavioral health service categories is a plus, including SATS (School-Aged Treatment Services), SAP (Student Assistance Program), GMH (General Mental Health), Success First, TBS (Therapeutic Behavioral Services), and others. Training on all SCCS programs is provided.
• Valid California driver’s license, proof of automobile insurance, and CPR/First Aid certification within 30 days of hire.

PHYSICAL REQUIREMENTS:

• Required to occasionally lift and carry 10–20 pounds.
• Regularly required to sit and use a computer and telephone headset for extended periods. Regularly required to stand, walk, and climb stairs. Staff may be assigned to support multiple SCCS sites across San Bernardino and Orange Counties.

EOE, INCLUDING DISABILITY/VETS

We are an equal opportunity employer and consider all qualified applicants for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, ancestry, age, disability, medical condition, genetic information, marital status, veteran status, or any other protected characteristic under California law.

Management reserves the right to add, change, delete or rescind duties or responsibilities of positions within the job classification at any time.