Claims Processing Supervisor

TRILLIUM HEALTH RESOURCES

1d • 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 Health Resources has a career opening for a Claims Processing Supervisor to join our team! The Claims Processing Supervisor is responsible for leading, maintaining, and enhancing the Medicaid and State funded claims processing services. This position will work closely with the provider network, Claims Processing Assistants, and various departments within Trillium to effectively resolve provider issues related to claims submissions and payments. Key responsibilities include engaging in all aspects of claims adjudication, adjustments, and reporting, both administrative and technical. Furthermore, this position involves training staff on the essential duties linked to claims processing, making a strong grasp of the operational claims system and the overall workflow crucial for success in this role.

Requirements

• High School diploma/GED and six (6) years of experience in a business-related field; OR
• Associate’s degree and four (4) years of experience in a business-related 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.

Nice To Haves

• Experience in claims processing.
• Experience with processing State-funded and Medicaid claims is a plus.

Responsibilities

• Ensure claim reports are able to be generated by Claims Processing Assistants to work, will generate and distribute reports if needed.
• Ensure Claim Processing Assistants analyze, research, and complete corrections, denials, etc., as needed.
• Interact with the provider network and between providers and Claims Processing Assistants, addressing payment and claim processing issues.
• Maintain an understanding of the entire claims management system.
• Answer phone calls and provide assistance to providers with claims questions.
• Track and update Trillium’s ticket system to answer Provider questions.

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)
• 401k with 5% employer match and immediate vesting
• Public Service Loan Forgiveness (PSLF) qualifying employer
• Quarterly stipend for remote work supplies

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED
• Number of Employees: 501-1,000 employees