Claims Director
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 Health Resources has a career opening for a Claims Director to join our team! This position provides leadership and management for the Claims staff, in the Claims Department, as applicable. The Claims Director is responsible for the processing of all claims, the data elements required to process claims, in addition to the reporting and analysis of claims data. Position is responsible for identification of Medicaid and State Funded services (fee-for-service and Medicaid Waiver services) including retroactive Medicaid coverage for paid claims. This position may interact with the provider community to address specific billing issues as well as other stakeholders including but not limited to the Department of Health and Human Services. Position is responsible for training staff on claims processing and reporting and analysts’ duties. Position is also required to work closely with other leadership members. This position requires knowledge of the operating claims system, accounting system, data reporting, and overall claims processing and financial analysis operations.
Requirements
- Bachelor’s degree in a business field and a minimum of three (3) years’ experience with extensive claims filing, data reporting, and financial analysis. Knowledge of Professional (Form CMS1500) Institutional (UB04) billing form, ICD-10/CPT/HCPCS coding/CAQH, HIPAA and claims processing.
- Must have a valid driver’s license
- Must reside within North Carolina
- Must be able to travel within catchment as required.
Nice To Haves
- Master’s degree in related business field.
- Supervision of two (2) or more employees.
Responsibilities
- Provide leadership, direction and management of the department.
- Responsible for gathering, researching and analyzing various data to aid Executive Management in decisions regarding provider services.
- Responsible for ensuring the identification of Medicaid and state funded covered services including retroactive Medicaid coverage to ensure appropriate enrollment and claims payment.
- Responsible for interaction between providers and department staff to address any enrollment, payment and billing issues.
- Responsible for maintaining an understanding of the entire claims management/AR system.
- Responsible for maintaining an understanding of Medicaid and State funded billing rules.
Benefits
- 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) https://www.myncretirement.gov/systems-funds/local-governmental-employees-retirement-system-lgers/lgers-handbook [https://www.myncretirement.gov/systems-funds/local-governmental-employees-retirement-system-lgers/lgers-handbook]
- 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
Director
