What are the responsibilities and job description for the Senior Claims Specialist position at Trillium Health Resources?
Pay Plan Title
Data Analyst
Working Title
Senior Claims Specialist
FLSA Status
Non-Exempt
Posting Salary Range
$42,102 - $61,546
Office Location:
Remote within North Carolina
Posting Details
Make an Impact
Trillium Health Resources is a Tailored Plan and Managed Care Organization (MCO) serving 46 counties across North Carolina. We manage services for individuals with serious mental health needs, substance use disorders, traumatic brain injuries, and intellectual/development (IDD) disabilities. Our mission is to help individuals and families build strong foundations for healthy, fulfilling lives.
Why Work for Us
Trillium believes that empowering others begins with supporting our team. We offer our employees:
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
Every day, our work changes lives - from children thriving through early intervention and school-based therapies, to adults with severe mental illness living independently and contributing to their communities.
If you are looking for a unique opportunity to make a tangible impact on the lives of others, apply today!
What We're Looking For
Trillium Health Resources has a career opening for a Senior Claims Specialist to join our team! The Senior Claims Specialist performs 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. This position is also responsible for assisting providers by phone or email with claims processing questions as well as communicating with internal and external stakeholders to facilitate efficient claims resolution.
On a Typical Day, You Might
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.
Analyze, audit and take appropriate actions for claims delayed for adjudication due to rejection errors.
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.
Recognize and report suspected system issues or concerns to immediate supervisor for follow-up based on data analysis.
Data Analyst
Working Title
Senior Claims Specialist
FLSA Status
Non-Exempt
Posting Salary Range
$42,102 - $61,546
Office Location:
Remote within North Carolina
Posting Details
Make an Impact
Trillium Health Resources is a Tailored Plan and Managed Care Organization (MCO) serving 46 counties across North Carolina. We manage services for individuals with serious mental health needs, substance use disorders, traumatic brain injuries, and intellectual/development (IDD) disabilities. Our mission is to help individuals and families build strong foundations for healthy, fulfilling lives.
Why Work for Us
Trillium believes that empowering others begins with supporting our team. We offer our employees:
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
Every day, our work changes lives - from children thriving through early intervention and school-based therapies, to adults with severe mental illness living independently and contributing to their communities.
If you are looking for a unique opportunity to make a tangible impact on the lives of others, apply today!
What We're Looking For
Trillium Health Resources has a career opening for a Senior Claims Specialist to join our team! The Senior Claims Specialist performs 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. This position is also responsible for assisting providers by phone or email with claims processing questions as well as communicating with internal and external stakeholders to facilitate efficient claims resolution.
On a Typical Day, You Might
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.
Analyze, audit and take appropriate actions for claims delayed for adjudication due to rejection errors.
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.
Recognize and report suspected system issues or concerns to immediate supervisor for follow-up based on data analysis.
Salary : $42,102 - $61,546