Claims Relations Coordinator

TRILLIUM HEALTH RESOURCES • New Caledonia, AR

24d • 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 Relations Coordinator to join our Claims team. The primary responsibilities in this role include managing and coordinating claim issues received by providers, members, or other entities via telephone call, email, and ticket system. The coordination of claim issues includes providing support and information to the provider community. This position will research and gather necessary information regarding claim issues and relay the resolution and/or summary of these issues to the provider community. This position will also be responsible for tracking, reviewing, and coordinating timely and accurate responses that may include inquiries, claims issues, and escalations submitted by the State Department.

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

• Coordination and management of Claims Department Claims Relations Process.
• 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.
• Review trends of provider issues and make recommendations for updates needed in the Claims Processing System and Claims Staff training.
• Coordination and management of calls and tickets.

Benefits

• Typical working hours: 8:30 am – 5:00 pm
• 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

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