Benefit and Eligibility Specialist - Multiple Locations (8552)

Terros Health•Phoenix, AZ

13d•Onsite

About The Position

Terros Health is a healthcare organization focused on whole-person health through an integrated care delivery system. The Benefit and Eligibility Specialist is a key resource supporting patient access to healthcare services. This role involves insurance eligibility verification, enrollment assistance, financial screening, benefit navigation, and coverage retention. The specialist collaborates with patients, clinical teams, the Patient Access Center, community agencies, and payers to minimize barriers to care, ensure accurate coverage information, and support timely access to services. The position requires knowledge of Medicaid, Medicare, AHCCCS, commercial insurance plans, Sliding Fee Scale programs, and other benefit resources, promoting a patient-centered approach while ensuring compliance with regulations. The role is responsible for maintaining accurate patient coverage information, assisting with benefit applications and renewals, conducting outreach, 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 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