Appeals Support Specialist

TRILLIUM HEALTH RESOURCES

4h•Remote

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. The Appeals Support Specialist is responsible for providing confidential administrative and specialist support to General Counsel/Appeals Department, which includes review and mailings of all Adverse Benefit Determination Letters and Appeal Letters, mail tracking, assisting with meeting minutes, data review, and appeal file maintenance. Other duties may include tracking of all court documents.

Requirements

High School Diploma or GED.
Minimum of one (1) year clerical experience; OR Equivalent combination of higher education/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 with Microsoft Office suite
Four (4) years of clerical and office management experience

Responsibilities

Finalize the adverse benefit determination notification letters for clinical and administrative denials, which may include peer-to-peer decision letters, as necessary. This process includes reviewing the letter for quality assurance, completing the certified mail process, uploading letters to member records in TBS, and issuing a copy of the letter to the appropriate provider.
Ensure notification letters are sent to the member/guardian and provider accurately and timely based on the most current formats and timelines as established by State and Federal regulations, Tailored Plan and contractual requirements, and accreditation standards.
Assist providers, members, and other Trillium departments with technical assistance and answers general questions received via phone call or email related to adverse benefit determination and appeals letters.
Enter data in a timely manner into TBS, as needed, and utilize the Denials Module to review adverse benefit determination letters and ensure timeliness of all appeal letters and documents.
Provide administrative assistance with projects or assignments to the Appeals and Internal Compliance Departments, including maintaining various departmental files and accurate and timely tracking of departmental projects.

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
Typical working hours: 8:30 am – 5:00 pm; flexible work schedules with some roles 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