Claims Specialist II

Trillium Health Resources

North Carolina

Hybrid

USD 43,000 - 62,000

Full time

12 days ago

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Benefits offered by this job

Health Insurance

Remote work options

Paid time off + holidays

401k with employer match

PSLF qualifying employer

Remote work stipend

Job summary

Trillium Health Resources seeks a Claims Specialist II to analyze and audit claims per NC Medicaid guidelines. The role supports providers by phone/email and collaborates with stakeholders to resolve claims efficiently. Strong knowledge of billing and coding, plus travel availability within NC, is expected.

The position offers remote work within North Carolina, standard hours, and benefits. A high school diploma with relevant experience is required; an Associate’s degree is preferred.

Qualifications

High School Diploma or GED with 2 years in claims processing, billing or medical coding.
Must reside in North Carolina and have a valid driver's license.
Authorized to work in the United States without sponsorship now or in the future.
Travel within catchment as required.
Preferred: Associate’s degree in Healthcare Administration or related field.
Certifications such as CPC/CPB/CMRS are a plus.

Responsibilities

Analyze and audit claims adjudication results for NC Medicaid guidelines.
Review attachments and medical documentation to adjudicate claims.
Address delayed adjudication due to errors and take corrective actions.
Identify provider and system errors and communicate with stakeholders.
Ensure adherence to departmental policies and published rules.
Provide training and technical assistance on claim submission and denial management.

Skills

Claims processing

Billing

Medical coding

Travel readiness

Education

High School Diploma or GED

Associate’s degree in Healthcare Administration or related field (preferred)

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Claims Specialist II

Full Time Admin Support *Trillium office based location as specified below: US 2 Attachments

2 days ago Requisition ID: 3472

Salary Range: $42,765.00 To $61,546.00 Annually

Working Title: Claims Specialist II

FLSA Status: Non-Exempt

Posting Salary Range: $42,765 - $61,546

Office Location: Remote within North Carolina

POSTING DETAILS:

Make an Impact

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.

Why Work for Us ?

Trillium believes that empowering others begins with supporting our team. We offer our employees:

Competitive benefits and work-from-home options for most positions
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.

What We’re Looking For

Trillium Health Resources has a career opening for a Claims Specialist II to join our team! The Claims Specialist II performs data analysis, auditing and finalizes adjudication results for claims designated for pre-payment review and post payment review of claim adjudication results through research and knowledge of billing guidelines and policies established by CMS, and NC Medicaid as well as Trillium policies and procedures. This position is also responsible for assisting providers by phone or email with claims processing questions as well as communicating with internal and external stakeholders to facilitate efficient claims resolution.

On a typical day, you might:

Analyze and audit claims adjudication results to determine if claims were accurately submitted and processed according to NC Medicaid guidelines.
Analyze and audit claim attachments/medical documentation necessary to appropriately adjudicate a claim.
Analyze, audit and take appropriate actions for claims delayed for adjudication due to rejection errors.
Identify adjudication errors, provider billing errors, and the need for technical assistance.
Ensure the claims system and manual processes are incorporating required actions by reviewing and applying information from departmental trainings, published coverage policies and other NCDHHS documents.
Provide training, education and technical assistance to provider agencies based on analysis or audit findings related to basic claim submission guidelines, denial management, system use and updates.
Recognize and report suspected system issues or concerns to immediate supervisor for follow-up based on data analysis.

Employee Benefits:

Trillium knows that work/life balance is essential. That’s why we offer:

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
401k with 5% employer match and immediate vesting
Public Service Loan Forgiveness (PSLF) qualifying employer
Quarterly stipend for remote work supplies

Qualifications

Required:

High School Diploma or GED and two (2) years of experience in claims processing, billing, or medical coding; OR
Equivalent combination of education and experience.
Must have a valid driver’s license
Must reside within North Carolina
Must be able to travel within catchment as required.
Must be legally authorized to work in the United States without requiring sponsorship for employment now or in the future (ex: OPT F-1, J-1).

Preferred:

Associate’s degree in Healthcare Administration, Business, or a Human Services field (such as Psychology, Social Work, etc.)

Hospital claims experience and knowledge
Experience in the areas of physical health claims processing or medical coding
Experience working with Managed Care billing software
Certified Professional Coder (CPC), Certified Professional Biller (CPB), Certified Medical Reimbursement Specialist (CMRS) or similar certification preferred.

Deadline for Application: Open until filled

Pay Plan Title: Claims Specialist II