Claims Relations Coordinator

TRILLIUM HEALTH RESOURCES•Remote in North Carolina, NC, US, NC

5h•$54,106 - $67,210•Remote

About The Position

Trillium Health Resources is seeking a Claims Relations Coordinator to join their Claims team. This role is responsible for managing and coordinating claim issues received from providers, members, and other entities via phone, email, and a ticket system. The position involves providing support and information to the provider community, researching claim issues, and communicating resolutions. Additionally, the Claims Relations Coordinator will track, review, and coordinate timely responses to inquiries, claims issues, and escalations from the State Department. The work aims to change lives by supporting individuals with serious mental health needs, substance use disorders, traumatic brain injuries, and intellectual/developmental disabilities.

Requirements

High School diploma/GED with a minimum of six (6) years of experience in coordinating multiple deadlines, drafting and reviewing written correspondence, and maintaining files and/or research in a healthcare or public health setting which includes a minimum of six (6) years of extensive medical claims research including reviewing denials, member eligibility, communicating both written and verbally with the provider community, and analyzing claim reports; OR
Associate’s degree with a minimum of four (4) years of experience in coordinating multiple deadlines, drafting and reviewing written correspondence, and maintaining files and/or research in a healthcare or public health setting which includes a minimum of four (4) years of extensive medical claims research including reviewing denials, member eligibility, communicating both written and verbally with the provider community, and analyzing claim reports; OR
Bachelor’s degree with a minimum of two (2) years of experience in coordinating multiple deadlines, drafting and reviewing written correspondence, and maintaining files and/or research in a healthcare or public health setting which includes a minimum of two (2) years of extensive medical claims research including reviewing denials, member eligibility, communicating both written and verbally with the provider community, and analyzing claim reports; 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

Degree in Business Administration, Healthcare Administration, Human Services, Public Administration, Liberal Arts, or Humanities.
Experience in the public mental health field is highly desired due to the complexity of the work of organization.

Responsibilities

Coordinate and manage calls and tickets.
Ensure claims ticket queue and call logs are updated and responded to timely to allow for timely notifications to the provider community on the resolution and/or summary of their issues.
Conduct claims research, including, but not limited to, review of claims processing system, review of previous and current tickets in the Claims Support Queue, review of paper claim logs, working with other claims staff to learn history, third party biller impacts, Remittance Advice notifications and provider technical assistance.
Assist with drafting provider related communications.
Review trends of provider issues and make recommendations for updates needed in the Claims Processing System and Claims Staff training.