Claims Specialist II

🔥 4 minutes ago

🌲 North Carolina – Remote

🌲 North Carolina – Remote

💵 $42.8k - $61.5k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

📋 Claims Specialist

🚫👨‍🎓 No degree required

👻 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

• Perform data analysis and auditing for claims designated for pre-payment review • Review claims adjudication results through research and knowledge of CMS, NC Medicaid, and Trillium billing guidelines and policies • Analyze and audit claim attachments and medical documentation • Take appropriate actions for claims delayed due to rejection errors • Identify adjudication errors, provider billing errors, and technical assistance needs • Review and apply departmental trainings, published coverage policies, and NCDHHS documents • Provide training, education, and technical assistance to provider agencies on claim submission guidelines, denial management, system use, and updates • Assist providers by phone or email with claims processing questions • Communicate with internal and external stakeholders to facilitate efficient claims resolution • Report suspected system issues or concerns to the immediate supervisor

🎯 Requirements

• High School Diploma or GED and two (2) years of experience in claims processing, billing, or medical coding; 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 • Legally authorized to work in the United States without requiring sponsorship now or in the future • Preferred: Associate’s degree in Healthcare Administration, Business, or a Human Services field • Hospital claims experience and knowledge preferred • Experience in physical health claims processing or medical coding preferred • Experience with Managed Care billing software preferred • Certified Professional Coder (CPC), Certified Professional Biller (CPB), Certified Medical Reimbursement Specialist (CMRS), or similar certification preferred • Must pass a drug test as a condition of employment

🏖️ Benefits

• Competitive benefits • Work-from-home options for most positions • Flexible work schedules with management approval for some roles • Health insurance with no premium for employee coverage • Flexible Spending Accounts • 24 days of Paid Time Off (PTO) plus 12 paid holidays in the 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 • Professional growth opportunities • Collaborative, mission-driven work environment • Diverse, inclusive culture