Prepayment Review Clinician

TRILLIUM HEALTH RESOURCES

15h • 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 Prepayment Review Clinician to join our team! The Prepayment Review Clinician is responsible for maintaining knowledge of applicable Federal, State, and Accreditation requirements and ensuring providers, vendors and Trillium maintain compliance with these requirements through internal and external reviews.

Requirements

• Master’s degree.
• Minimum one (1) year of experience with behavioral health, mental health, substance abuse, developmental disabilities and/or co-occurring disorders populations or field.
• Fully licensed by the State of North Carolina as a LCMHC, LMFT, LCSW, LCAS, or 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 any of the following areas: healthcare compliance, knowledge of North Carolina Clinical Coverage Policies and billing requirements related to Medicaid, knowledge and understanding of Prepayment Review Process, public speaking, mediation and/or problem resolution, group facilitation, advocacy, and project management.
• Certified in Healthcare Compliance (CHC), Accredited Health Care Fraud Investigator (AFHI), Certified Fraud Examiner (CFE), or equivalent certifications.

Responsibilities

• Conduct clinical portions of the Prepayment Claims Review to ensure provider network and agency compliance with applicable laws and regulations prior to payment.
• Ensure all timeframes associated with Prepayment Claims review are identified, monitored and met by team throughout process.
• Provide appropriate communication, both verbally and written, throughout Prepayment Claims Review process with internal departments and external agencies, as appropriate.
• Assist with tracking logs related to Prepayment Claims Reviews.
• Maintain all documentation related to Prepayment Claims Review activities.

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