Benefit and Eligibility Specialist - Multiple Locations (8552)

Benefit And Eligibility Specialist - Multiple Locations

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

Description

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's 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.

The Benefit and Eligibility Specialist serve as a key resource in supporting patients' access to healthcare services through insurance eligibility verification, enrollment assistance, financial screening, benefit navigation, and coverage retention activities. The position collaborates with patients, clinical teams, Patient Access Center staff, community agencies, and payers to minimize barriers to care, ensure accurate coverage information, and support timely access to services. The Benefit & Eligibility Specialist maintains knowledge of Medicaid, Medicare, AHCCCS, commercial insurance plans, Sliding Fee Scale programs, and other available benefit resources. This position promotes a patient-centered approach while ensuring compliance with organizational, contractual, state, and federal requirements. The role is responsible for maintaining accurate patient coverage information, assisting with benefit applications and renewals, conducting outreach activities, and supporting continuity of care through proactive eligibility management.

Duties

• Supports patients in navigating insurance coverage, eligibility, enrollment, renewal, and financial assistance processes to promote access to care and continuity of coverage
• Conducts financial screening, eligibility verification and proactive coverage monitoring for Medicaid, Medicare, commercial insurance, sliding fee scale programs, and other funding sources; identifies and addresses potential coverage gaps or barriers to care.
• Assist patients with benefit applications, renewals, required documentation, and related follow-up activities, including coordination with outside agencies and community resources as needed.
• Utilizes payer portals, eligibility verification systems, state benefit systems, and EHR applications to verify coverage, update records, and resolve eligibility discrepancies.
• Maintains accurate demographic, financial, and payer information within the Electronic Health Record (EHR) and related systems to support continuity of care and operational accuracy
• Performs proactive outreach to patients regarding renewal deadlines, missing documentation, inactive coverage, or other issues impacting eligibility or access to services
• Collaborates closely with Patient Access Center (PAC), front office staff, Practice Managers, clinical teams, and other departments to support a seamless patient access and coverage experience
• Educates patients and staff regarding eligibility requirements, benefit programs, coverage changes, and available financial support resources
• Maintains complete, accurate and timely documentation of all patient interactions, eligibility determinations, outreach efforts and enrollment activities through tracking tools, reports, and productivity standards in accordance with organizational, contractual, and regulatory requirements
• Maintains compliance with HIPAA, AHCCCS, CMS, payer requirements, organizational policies, and all applicable federal and state regulations.
• Participates in workflow improvement and standardization efforts to support consistent eligibility and benefits processes across clinics and programs.

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 required; Associate's or Bachelor's degree in healthcare or related field preferred.
• A minimum one (1) year of experience in healthcare eligibility, patient access, insurance verification, benefits enrollment, medical office operations, behavioral health, community health, or related healthcare environment required.
• Experience working with Medicaid, Medicare, AHCCCS, commercial insurance plans, or public assistance programs preferred.
• Experience utilizing Electronic Health Records (EHR), payer portals, eligibility systems, and Microsoft Office applications preferred.
• Ability to communicate effectively with diverse patient populations, families, and interdisciplinary healthcare teams.
• Strong organizational, customer service, documentation, and problem-solving skills.
• Must have a valid Arizona driver's license, be 21 years of age with a minimum of 3 years driving experience, and meet requirements of Terros Health's driving policy
• Must successfully pass a TB screening and criminal background check