Senior Claims Specialist

🕒 Yesterday

🌲 North Carolina – Remote

🌲 North Carolina – Remote

💵 $41.1k - $59.5k / year

⏰ Full Time

🟠 Senior

📋 Claims Specialist

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Trillium Health Resources

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

⚕️ Healthcare Insurance

Healthcare Insurance • Mental Health • Substance Use

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, 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.

🎯 Requirements

• 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.

🏖️ Benefits

• 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