Appeals Specialist II

🔥 18 hours ago

🌲 North Carolina – Remote

🌲 North Carolina – Remote

💵 $56.3k - $69.9k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 0%

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Trillium Health Resources

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🏥 Healthcare

💼 Consulting

📦 Logistics

Healthcare • Consulting • Logistics

Trillium Health Resources is a leading specialty care manager (LME/MCO) for individuals with serious behavioral health, intellectual/developmental disabilities, and traumatic brain injury in North Carolina. The organization is committed to investing in the health and well-being of the communities it serves, providing services such as preventive health screenings, crisis intervention, and tailored care management. Trillium focuses on enhancing access to mental health and substance use services for its members and ensuring support for vulnerable populations.

📋 Description

• Manage assigned appeals, grievances, and/or complaint cases from intake through resolution • Investigate cases by gathering documentation, interviewing stakeholders, and analyzing findings • Evaluate case information to determine appropriate resolution and required actions • Prepare and issue acknowledgment and resolution letters within required time frames • Maintain complete case files in accordance with regulatory and accreditation standards

🎯 Requirements

• High school diploma or GED and six (6) years of experience in the Mental Health, Developmental Disabilities, and Substance Use services field; OR Associate's degree and four (4) years of experience in the Mental Health, Developmental Disabilities, and Substance Use services field; OR Bachelor's degree and two (2) years of experience in the Mental Health, Developmental Disabilities, and Substance Use services field; OR Equivalent combination of education and experience • Valid driver’s license • Must reside within North Carolina • Must be able to travel within catchment as required • Must be legally authorized to work in the United States without requiring sponsorship for employment now or in the future • Preferred: Experience working with provider claims, provider network, or provider sanctions • All candidates must pass a drug test as a condition of employment

🏖️ Benefits

• Competitive benefits • Work-from-home options for most positions • Flexible work schedules with some roles with management approval • 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

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