Member & Recipient Appeals Coordinator
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 believes that empowering others begins with supporting our team. We offer our employees a collaborative, mission-driven work environment, competitive benefits and work-from-home options for most positions, and opportunities for professional growth in a diverse inclusive culture. Every day, our work changes lives – from children thriving through early intervention and school-based therapies, to adults with severe mental illness living independently and contributing to their communities. If you are looking for a unique opportunity to make a tangible impact on the lives of others, apply today!
Requirements
- High School Diploma/GED and six (6) years of experience in Behavioral/Mental Health, Developmental Disabilities, and Substance Abuse services; OR Associate’s degree and four (4) years of experience in Behavioral/Mental Health, Developmental Disabilities, and Substance Abuse services; OR Bachelor’s degree and two (2) years of experience in Behavioral/Mental Health, Developmental Disabilities, and Substance Abuse services; 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 a Human Services field.
- Experience in the public mental health field is highly desired due to the complexity of the work of the organization.
Responsibilities
- Coordinate and manage Trillium’s Medicaid and Non-Medicaid Member Appeal Processes.
- Ensure notification letters are updated and sent to the member/guardian and provider accurately and timely based on the most current formats and timelines as established by State and Federal regulations and contractual and accreditation standards.
- Track appeal requests and set up internal appeals panels, when needed. Continue tracking and facilitating Trillium involvement in Appeals process through resolution.
- Aid general counsel and external contracted legal representatives in preparation for Trillium-specific Appeals related cases.
- Assist in completion of data reports.
Benefits
- Competitive benefits
- Work-from-home options for most positions
- A collaborative, mission-driven work environment
- Opportunities for professional growth in a diverse inclusive culture
- 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
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
