Eligibility Specialist

Eligibility Specialist

Position Type: Full Time Job Shift: Day Shift Education Level: High School Diploma/GED Travel Percentage: In-Office Category: Contracts/Credentialing

Terros Health is a healthcare organization of caring people, guided by our core values of integrity, compassion and empowerment. We engage people in whole person health through an integrated care delivery system, thus establishing a medical home for our patients. In caring for the whole person, we focus on overall wellness through physical health, mental health and substance use care. Our mission is to provide extraordinary care by empowered people through exceptional outcomes.

Under the agency's policies and professional requirements, and under the direct supervision of the Sr Director of Patient Access and Practice Operations, this position is responsible for determining, documenting, auditing and maintaining accurate and current enrollment, eligibility and benefit coverage for clients/patients to ensure appropriate and timely reimbursement for services. This position provides excellent customer services to both internal and external customers. Position requires knowledge of behavioral health and medical healthcare systems, insurance reimbursement policies, federal and state requirements, internal policies and agency contract requirements

Multiple Locations are open: 27th Ave, 51st, E. McDowell, Oak, Central Ave, Olive, Stapley, South Mountain

• Obtains and reviews for eligibility available financial support options for clients/patients, including identifying requirements and/or expectations related to prior authorization, co-payment, co-insurance, and deductibles.
• Reconciles eligibility/insurance coverage discrepancies.
• Obtains and provides accurate information related to financial support including the state Regional Behavioral Health Authority, Medicaid (Title XIX/XXI and Non-Title covered services), Medicare, Federal Marketplace, and other commercial insurance plans to ensure timely payment/reimbursement for services
• Validates all client/patient eligibility information, ensuring timely and accurate documentation into the client/patient's electronic health record in accordance with agency and department standards.
• Identifies and assists in resolving problems with client/patient eligibility/insurance coverage.
• Maintain thorough understanding of different insurance contacts/payers and keep abreast of contract changes
• Completes, monitors and audits Families F.I.R.S.T (Families in Recovery Succeeding Together) data entry for internal and collaborator assessments for compliance
• Coordinates with Practice Managers and/or other identified front office staff as needed and assists with entry of client payer information into the EHR system to ensure payer information is maintained as current.
• Monitors eligibility renewal/expiration information and work with Practice Managers and other appropriate staff to avoid lapses in coverage for clients/patients
• Ensures effective communication with all relevant staff and provides timely notification of any change in a client's benefit status to the Practice Managers who will assist with notifications to clients/patients.
• May be required to complete Families F.I.R.S.T (Families in Recovery Succeeding Together) assessments
• Utilizes the department team to discuss, enhance and resolve issues.

Benefits & Wellness

• Multiple medical plans - including a no premium plan for employees and their families
• Multiple dental plans - including orthodontia
• Financial well-being - 401(k) with a company match, interest free medical line of credit, financial education, planning, and support
• 4 Weeks of paid time off in the first year
• Wellness program
• Pet Insurance
• Group life and disability insurance
• Employee Assistance Program for the Whole Family
• Personal and family mental and physical health access
• Professional growth & development - including scholarships, clinical supervision, and CEUs
• Tuition discounts with GCU and The University of Phoenix
• Working Advantage - Employee perks and discounts
  • Gym memberships
  • Car rentals
  • Flights, hotels, movies and more
• Bilingual pay differential

Qualifications

• High School Diploma or GED/ Associates Degree in healthcare field preferred.
• 1 3 years' experience in behavioral health and/or medical health care fields coordinating healthcare benefits, validating members coverage, entering accurate benefit information.
• Knowledge and understanding of commercial and federal and/or state insurance benefit and eligibility programs (Regional Behavioral Health Authority, Medicaid, Medicare, Long Term Care, adult and child/adolescent programs, etc.)
• Computer skills including Microsoft Word, Intermediate Excel, Outlook. Experience with ClaimTrak and NextGen preferred.
• Excellent communication skills.
• Ability to multi-task; high level of accuracy and attention to detail a must.
• Able to work independently and in a team atmosphere.
• Bilingual preferred.
• Must pass a TB test, a criminal background check and drug test