Appeals Specialist II
About The Position
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. 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, and 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! Trillium Health Resources has a career opening for an Appeals Specialist II to join our team! The Appeals Specialist II manages appeals or grievance cases from intake through resolution. The role investigates concerns, evaluates findings, and prepares determination communications to ensure accurate, timely resolution and compliance with regulatory and accreditation requirements.
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.
- Must have a valid driver’s license.
- Must reside within North Carolina.
- Must be able to travel within catchment as required.
Nice To Haves
- Experience working with provider claims, provider network, or provider sanctions.
Responsibilities
- 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.
Benefits
- Competitive benefits and work-from-home options 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
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
