Compliance Specialist III
TRILLIUM HEALTH RESOURCES•Remote in North Carolina, NC, US, NC
•$68,890 - $92,138•Remote
About The Position
Trillium Health Resources has a career opening for a Compliance Specialist III to join our team! Compliance Specialist III performs clinical compliance reviews and evaluates prepayment claims to ensure adherence to regulatory and coverage requirements. The role applies clinical judgment to assess documentation, determine compliance, and direct corrective actions to prevent improper payments and support program integrity.
Requirements
- Master's degree and one (1) year of experience with behavioral health, mental health, substance use, developmental disabilities, and/or co-occurring disorders populations or field.
- Active North Carolina licensure as: Licensed Clinical Social Worker (LCSW), Licensed Clinical Mental Health Counselor (LCMHC), Licensed Marriage and Family Therapist (LMFT), Licensed Psychological Associate (LPA), Licensed Clinical Addictions Specialist (LCAS), or Registered Nurse (RN)
- 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 clinical healthcare audits, monitoring, or reviews.
Responsibilities
- Conduct clinical reviews of pre- and post-payment claims to verify compliance.
- Evaluate clinical documentation against coverage policies and service definitions.
- Apply independent clinical judgment to determine compliance and identify discrepancies.
- Manage assigned compliance cases from intake through resolution.
- Investigate allegations of non-compliance.
- Evaluate case findings and determine appropriate corrective actions.
- Maintain complete case files in accordance with regulatory and accreditation standards.
- Monitor review timelines to ensure completion within required timeframes.
Benefits
- Competitive benefits and work-from-home options 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
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
