Manager of Eligibility and Benefits Central Ave (7130)

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.

This role serves as the organizations 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.

Position requires knowledge of healthcare systems insurance reimbursement policies federal and state requirements internal policies and integrated behavioral health and medical care operations.

HOPE HEALTH HEALING

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Most Admired Companies of& 2023as awarded by AZ Big Media.

• 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

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Benefits & Wellness

• 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

• Bachelors 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 OneFingerprint 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

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.