Senior Claims Specialist

🕒 vor 10 Tagen

🌲 North Carolina – Remote

🌲 North Carolina – Remote

💵 €41.102 - €59.518 / Jahr

⏰ Vollzeit

🟠 Senior

📋 Schadensspezialist

Jetzt Bewerben

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Trillium Health Resources

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1001 - 5000 Mitarbeiter

⚕️ Krankenversicherung

Healthcare Insurance • Mental Health • Substance Use

Trillium Health Resources ist ein führender Spezialanbieter von Pflege-Management (LME/MCO) für Menschen mit schwerwiegenden Verhaltensstörungen, geistigen/entwicklungsbezogenen Behinderungen und Schädel-Hirn-Traumata in North Carolina. Die Organisation ist bestrebt, in die Gesundheit und das Wohlbefinden der Gemeinden, denen sie dient, zu investieren und bietet Dienstleistungen wie präventive Gesundheitsuntersuchungen, Krisenintervention und maßgeschneidertes Pflege-Management an. Trillium konzentriert sich darauf, den Zugang zu psychischen Gesundheits- und Substanzgebrauchsdiensten für seine Mitglieder zu verbessern und Unterstützung für gefährdete Bevölkerungsgruppen sicherzustellen.

Beschreibung

• Perform data analysis, auditing and finalizes adjudication results for claims designated for pre-payment review and post payment review of claim adjudication results through research and knowledge of billing guidelines and policies established by CMS, and NC Medicaid as well as Trillium policies and procedures. • Assist providers by phone or email with claims processing questions as well as communicating with internal and external stakeholders to facilitate efficient claims resolution. • Analyze and audit claims adjudication results to determine if claims were accurately submitted and processed according to NC Medicaid guidelines. • Analyze and audit claim attachments/medical documentation necessary to appropriately adjudicate a claim. • Identify adjudication errors, provider billing errors, and the need for technical assistance. • Ensure the claims system and manual processes are incorporating required actions by reviewing and applying information from departmental trainings, published coverage policies and other NCDHHS documents. • Provide training, education and technical assistance to provider agencies based on analysis or audit findings related to basic claim submission guidelines, denial management, system use and updates.

🎯 Anforderungen

• High School Diploma/GED and two (2) years of experience in the claims processing or billing or medical coding field; OR Equivalent combination of education/experience. • Must have a valid driver’s license • Must reside within North Carolina • Must be able to travel within catchment as required. • Preferred: Associate’s degree in Healthcare Administration, Business, or a Human Services field (such as Psychology, Social Work, etc.) • Hospital claims experience and knowledge • Experience in the areas of physical health claims processing or medical coding • Experience working with Managed Care billing software • Certified Professional Coder (CPC), Certified Professional Biller (CPB), Certified Medical Reimbursement Specialist (CMRS) or similar certification preferred.

🏖️ Vorteile

• Health Insurance with no premium for employee coverage • Flexible Spending Accounts • 24 days of Paid Time Off (PTO) plus 12 paid holidays in your first year • NC Local Government Retirement Pension (defined-benefit plan) • 401k with 5% employer match and immediate vesting • Public Service Loan Forgiveness (PSLF) qualifying employer • Quarterly stipend for remote work supplies