Manager of Eligibility and Benefits - Central Ave (7130)

Terros Health•Phoenix, AZ

36d•Onsite

About The Position

Terros Health is seeking a Manager of Eligibility & Benefits. This position provides leadership, management, and operational oversight of the centralized Eligibility and Benefits functions to ensure accurate insurance verification, coverage continuity, enrollment support, and timely reimbursement for services. This role reports to the Sr. Director and serves as the organization’s subject matter expert (SME) on insurance eligibility, coverage requirements, and benefit programs including Medicaid, Medicare, Commercial insurance product lines, and other funding sources. The Manager ensures standardized workflows, strong collaboration with Patient Access, clinics, and Revenue Cycle, and supports a patient-centered approach to navigating insurance and coverage requirements. This position plays a key role in proactively identifying coverage risks, supporting renewal and redetermination processes, and helping prevent disruptions to patient care. The role requires knowledge of healthcare systems, insurance reimbursement policies, federal and state requirements, internal policies, and integrated behavioral health and medical care operations. Terros Health was recognized as one of the 'Most Admired Companies of 2020, 2022 & 2023' by AZ Big Media.

Requirements

Bachelor’s degree in healthcare administration, business, behavioral health, or related field; or equivalent experience.
Minimum three (3) years of management or supervisory experience in healthcare eligibility, patient access, or insurance operations.
Experience in healthcare services and medical insurance fields including RBHA, Commercial, Medicare, and Medicaid product lines
Knowledge of behavioral health and primary care front and back-office operations, demographic and billing processes.
Experience working with Electronic Health Record systems.
Proficient in Microsoft Office applications.
Valid Arizona Level One Fingerprint Clearance Card or ability to obtain an Arizona Level One Fingerprint Clearance Card.
Current Arizona Driver License and a current satisfactory 39-month Motor Vehicle Record (MVR).
Must pass background check, TB test and other pre-employment screening

Responsibilities

Responsible for managing the operations of centralized Eligibility and Benefits functions across all product lines of business including RBHA, Commercial, Medicare, and Medicaid, including ACC health plans, ensuring all eligibility and coverage-related activities are performed within established quality and productivity standards.
Serves as the organizational SME for insurance eligibility, coverage rules, enrollment requirements, redeterminations, prior authorization expectations, and payer-specific guidelines
Oversees eligibility verification, enrollment assistance, renewal monitoring, and coverage continuity efforts to ensure accurate documentation and to proactively prevent gaps in patient coverage that could impact access to care.
Ensuring all departmental policies and procedures are documented, implemented, implemented, reviewed annually, and aligned with RBHA, ACC, ADHS/BHS, federal, and contractual requirements.
Partners with Patient Access Center leadership to ensure seamless intake-to-coverage workflows, including standardized escalation pathways between PAC, Eligibility Specialists, and Benefits Enrollment Specialists.
Collaborates with Revenue Cycle to monitor and reduce eligibility-related claim denials and improve front-end accuracy impacting reimbursement
Oversee the implementation and regular utilization of electronic eligibility functions (Clearinghouse, BBP, RTS (Real Time Services), and 270/271 transactions) to ensure accurate client information is available in the EHR.
Participates with IT/Systems, EHR, and EPM teams to ensure eligibility and enrollment standards for electronic data entry and required documentation are consistently maintained.
Provides operational support across all clinic programs and service lines by ensuring eligibility and benefits staff are appropriately deployed to support FQHCs, SMI clinics, rehabilitation services, and other clinical programs
Represents the Eligibility and Enrollment Department on committees, task forces, and work groups as needed.
Ensures timely completion and submission of required internal and external reporting, including contractual deliverables and Quality Assurance activities.
Oversee front-end and back-end audits to confirm accurate payer/guarantor data entry and compliance with contractual and regulatory requirements.
Responsible for recruitment, hiring, onboarding, coaching, and performance management of Eligibility and Benefits staff in accordance with company policy.
Conducts regular one-on-one meetings, team meetings, and performance evaluations to foster a high-performing department.
Monitors staffing and payroll to ensure compliance with budgeted FTEs.
Develops, monitors, and reports on performance metrics including Coverage verification at scheduling, Enrollment and renewal completion rates, Coverage renewal/redetermination completion rates, Eligibility resolution turnaround time, Eligibility-related claim denial trends, Individual and team productivity metrics

Benefits

Multiple medical plans - including a no premium plan for employees and their families
Multiple dental plans - including orthodontia
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