Compliance Specialist III

Trillium Health Resources; North Carolina; Hybrid; USD 69,000 - 92,000; Full time

Benefits offered by this job

Work-from-home options

Health Insurance with no premium

Flexible Spending Accounts

Paid Time Off

401k with employer match

PSLF qualifying employer

Remote work stipend

Job summary

Trillium Health Resources is seeking a Compliance Specialist III to perform clinical compliance reviews and evaluate prepayment claims for regulatory adherence. The role applies clinical judgment to assess documentation and direct corrective actions to prevent improper payments and support program integrity.

The position requires a Master's degree and NC licensure with travel within the NC catchment region; remote work from North Carolina is possible.

Qualifications

• Master's degree and one year of experience in behavioral health, mental health, substance use, developmental disabilities, or related fields.
• Active North Carolina licensure as LCSW, LCMHC, LMFT, LPA, LCAS, or RN.
• Valid driver's license and NC residency; ability to travel within catchment.

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 standards.
• Monitor review timelines to ensure timely completion.

Skills

Clinical reviews

Documentation evaluation

Case management

Education

Master's degree

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.

Compliance Specialist III

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

Salary Range: $68,890.00 To $92,138.00 Annually

Pay Plan Title: Compliance Specialist III

Working Title: Compliance Specialist III

Position Number: 91503

FLSA Status: Exempt

Posting Salary Range: $68,890 - $92,138

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 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.

On a typical day, you might:

• 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.

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 available for some positions 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:

• 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)
  • Registered Nurse (RN)
• Must have a valid driver's license
• Must reside within North Carolina.
• Must be able to travel within catchment as required.

Preferred:

• Experience in clinical healthcare audits, monitoring, or reviews.

Trillium Health Resources is an Equal Employment Opportunity (EEO) employer and a drug-free workplace. All candidates must pass a drug test as a condition of employment.

#Innovation #Technology #Careers #NorthCarolina #BehavioralHealth

Attachments (2)

Tips for Applying to or Interviewing with Trillium 10.17.25.pdf

GOVLC009 - COMPLIANCE SPECIALIST III.pdf