Compliance Specialist III

🔥 4 hours ago

🌲 North Carolina – Remote

🌲 North Carolina – Remote

💵 $68.9k - $92.1k / year

⏰ Full Time

🟢 Junior

🚔 Compliance

👻 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 clinical compliance reviews • Evaluate prepayment claims to ensure adherence to regulatory and coverage requirements • Conduct clinical reviews of pre- and post-payment claims to verify compliance • Evaluate clinical documentation against coverage policies and service definitions • Apply independent clinical judgment to determine compliance and identify discrepancies • Manage assigned compliance cases from intake through resolution • Investigate allegations of non-compliance • Evaluate case findings and determine appropriate corrective actions • Maintain complete case files in accordance with regulatory and accreditation standards • Monitor review timelines to ensure completion within required timeframes

🎯 Requirements

• Master's degree • One (1) year of experience with behavioral health, mental health, substance use, developmental disabilities, and/or co-occurring disorders populations or field • Active North Carolina licensure as a Licensed Clinical Social Worker (LCSW), Licensed Clinical Mental Health Counselor (LCMHC), Licensed Marriage and Family Therapist (LMFT), Licensed Psychological Associate (LPA), Licensed Clinical Addictions Specialist (LCAS), or Registered Nurse (RN) • Must have a valid driver's license • Must reside within North Carolina • Must be able to travel within catchment as required • All candidates must pass a drug test as a condition of employment

🏖️ Benefits

• A collaborative, mission-driven work environment • Competitive benefits and work-from-home options for most positions • Opportunities for professional growth in a diverse inclusive culture • Flexible work schedules available for some positions with management approval • Work-from-home options available for most positions • 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