Benefit and Eligibility Specialist - Multiple Locations (8983)

Terros Health•Phoenix, AZ

69d•Onsite

About The Position

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.

Requirements

High School Diploma or GED required
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.
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

Nice To Haves

Associate’s or Bachelor’s degree in healthcare or related field preferred.
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.

Responsibilities

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

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