Benefit and Eligibility Specialist - Multiple Locations (8983)

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.

HOPE ~ HEALTH ~ HEALING

Several Open Positions and Locations:

• Priest- 1642 S Priest Dr Building 6 Ste 101 Tempe Az 85281
• Oak- 4451 E Oak St Phoenix Az 85008
• McDowell- 4909 E McDowell Rd Phoenix Az 85008
• Mitchell- 40 E Mitchell Dr Phoenix Az 85012
• Stapley- 1111 S Stapley Dr, Mesa, Az 85204

The duties listed below are intended only as illustrations of the types of work that may be performed. The omission of specific statements of duties does not exclude them from the position if the work is similar, related or a logical assignment to this classification.

• 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

We invest in the health, well-being, and success of our employees and their families by offering comprehensive benefits, wellness resources, and opportunities to grow both personally and professionally

• Multiple medical plan options, including a no-premium plan for employees and their families

• Multiple dental plan options, including orthodontic coverage

• Vision insurance

• Group life and disability insurance

• Pet insurance

• 401(k) plan with company match

• Interest-free medical line of credit

• Financial education, planning, and support resources

• Monetary company contribution toward eligible benefits

• Bilingual pay differential

• Generous Paid Time Off (PTO) - 3 weeks off in the first year

• Paid Sick Time

• 10 paid holidays annually

• Comprehensive wellness program featuring wellness challenges, activities, and prizes

• Employee Assistance Program (EAP) available to employees and their family members

• Trip Reduction Program

• Ongoing professional growth and career development opportunities, including:

• Scholarships

• Clinical supervision

• Continuing Education Units (CEUs)

• Tuition discounts through Grand Canyon University, University of Phoenix, and Northern Arizona University (NAU)

• Access to the Working Advantage Employee Discount Program, with savings on:

• Gym memberships

• Car rentals

• Flights, hotels, movie tickets, and more

• 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

Physical demands of this position are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.