Terros Health

  • Eligibility Enrollment Specialist

    Job Locations US-AZ-Phoenix
    Job ID
    2018-3177
    # of Openings
    1
    Category
    Administrative/Clerical
    Program
    Business Office
    Weekly Hours
    40
  • Overview

    We are pleased to share an exciting opportunity at Terros Health for a Benefit Eligibility Specialist at our busy 27th Avenue medical clinic.

     

    Terros is a fully integrated healthcare organization of caring people, guided by our core values of integrity, compassion and empowerment. For more than four decades, the heart of everything we do is inspiring change for life. We help people manage addiction and mental illness, provide primary medical care, restore families, support our veterans, and connect individuals to the care they need.

     

    If you are interested in working for one of the State's Leading Healthcare Organizations that promotes Integrity, Compassion, and Empowerment, we encourage you to apply!  If you are energized by helping people during their most challenging times, this vital opportunity will be rewarding.

    Responsibilities

    Under the agency’s policies and professional requirements, and under the direct supervision of the Director of Enrollment and Eligibility, this position is responsible for determining, documenting, auditing and maintaining accurate and current enrollment, eligibility and benefit coverage for clients/patients to ensure appropriate and timely reimbursement for services.  This position provides excellent customer services to both internal and external customers.   Position requires knowledge of behavioral health and medical healthcare systems, insurance reimbursement policies, federal and state requirements, internal policies and agency contract requirements.

    • Obtains and reviews for eligibility available financial support options for clients/patients, including identifying requirements and/or expectations related to prior authorization, co-payment, co-insurance, and deductibles.
    • Reconciles eligibility/insurance coverage discrepancies.
    • Obtains and provides accurate information related to financial supports including the state Regional Behavioral Health Authority, Medicaid (Title XIX/XXI and Non-Title covered services), Medicare, Federal Marketplace, and other commercial insurance plans to ensure timely payment/reimbursement for services.
    • Validates all client/patient eligibility information; ensuring timely and accurate documentation into the client/patient’s electronic health record in accordance with agency and department standards.
    • Identifies and assists in resolving problems with client/patient eligibility/insurance coverage.
    • Maintain thorough understanding of different insurance contacts/payers and keep abreast of contract changes.
    • Maintains tracking spreadsheets related to client benefits and eligibility status as required by the agency and or funding sources. Provides updated reports to agency leadership as needed for submission per contract deliverable requirements
    • Coordinates with Practice Managers and/or other identified front office staff as needed and assists with entry of client payer information into the EHR system to ensure payer information is maintained as current.
    • Monitors eligibility renewal/expiration information and works with Practice Managers and other appropriate staff to avoid lapses in coverage for clients/patients.
    • Ensures effective communication with all relevant staff and provides timely notification of any change in a client’s benefit status to the Practice Managers who will assist with notifications to clients/patients.
    • Utilizes the department team to discuss, enhance and resolve issues.
    • Utilizes payer resources, web portals and customer service phone lines to obtain eligibility information in a timely manner.
    • Assists with outreach, engagement and other requirements related to contracted health plan clients/patients paneled to the agency.
    • Assists with auditing as necessary.
    • Maintains knowledge of behavioral health and primary care front office & back office operations.
    • May be required to travel to various company facilities.
    • When determined clinically appropriate, assists with requests for inter-RBHA transfers.

    Qualifications

    • High School Diploma or GED/ Associates Degree in healthcare field preferred.
    • 1 – 3 years’ experience in behavioral health and/or medical health care fields coordinating healthcare benefits, validating members coverage, entering accurate benefit information.
    • Knowledge and understanding of commercial and federal and/or state insurance benefit and eligibility programs (Regional Behavioral Health Authority, Medicaid, Medicare, Long Term Care, adult and child/adolescent programs, etc.)
    • Computer skills including Microsoft Word, Intermediate Excel, Outlook. Experience with ClaimTrak and NextGen preferred.
    • Excellent communication skills.
    • Bilingual preferred.
    • Must have valid Arizona driver’s license, be 21 years of age with minimum 3 years driving experience, and meet requirements of Terros Health’s driving policy
    • Must have a valid Arizona Fingerprint Clearance card or apply for an Arizona fingerprint clearance card (Level 1) within 20 working days of assuming role.
    • Must pass a TB Test.

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