Provider Appeals Coordinator

Trillium Health Resources; United States; Remote; USD 53,000 - 67,000; Full time

Job summary

Trillium Health Resources, a key player in Managed Care Organization, seeks a Provider Appeals Coordinator. This remote role focuses on managing appeals related to provider actions, ensuring compliance with regulations and maintaining accurate appeal data to support the organization’s commitment to mental health and community service. With strong emphasis on work-life balance and competitive benefits, this position is vital to empower both providers and individuals in the community.

Benefits

Health Insurance - no premium for employee coverage

Paid Time Off (PTO) of 24 days, plus 12 paid holidays

401k with 5% employer match & immediate vesting

NC Local Government retirement pension

Flexible Spending Accounts

Public Service Loan Forgiveness Qualifying Employer

Remote work option for most positions

Qualifications

• Experience in Behavioral/Mental Health or Developmental Disabilities required.
• Preferred experience in the public mental health field.
• Valid driver’s license needed.

Responsibilities

• Manage and coordinate provider appeals including claims and adverse actions.
• Draft resolution letters and monitor appeals policies.
• Serve as backup for member appeals team.

Skills

Behavioral Health

Mental Health

Substance Abuse

Data Tracking

Education

Associate’s Degree

Bachelor’s Degree in Human Services

Job description

Pay Plan Title:Coordinator

Working Title: Provider Appeals Coordinator

FLSA Status: Exempt

Posting Salary Range:$53,045 - $66,837

Office Location: Remote within North Carolina.

POSTING DETAILS:

Make an Impact

Trillium Health Resources is a Tailored Plan and Managed Care Organization (MCO) that manages serious mental health, substance use, traumatic brain injury, and intellectual/developmental disability services in North Carolina. Serving in 46 counties, we help individuals and their families strengthen well-being and build foundations for a healthy life.

Join our team as we empower others to live their best lives by providing access to quality healthcare. We offer a challenging, engaging work environment where staff take home more than a paycheck. Every day, we see the results of our dedication – in the smiles of children on our accessible playgrounds and in the pride on the face of an adult cooking a meal for the first time. Working at Trillium Health Resources is more than just a job; it is an opportunity to make a direct impact on the communities we serve.

At Trillium, we know that empowering others begins with supporting and developing our team. That’s why we offer competitive benefits and work-from-home flexibility so that our employees thrive outside of the office. We’re also committed to building a diverse, inclusive culture where all employees have the potential to grow professionally and personally.

What We’re Looking For

Trillium Health Resources has a career opening for a Provider Appeals Coordinator. This position is responsible for managing and coordinating provider appeals, including adverse action appeals, claims appeals, and provider compliant appeals. This is a vital role at Trillium, which requires direct interaction with providers, members, and Trillium staff members. The coordination of provider appeals includes: providing support and information to providers seeking to appeal a Trillium action; scheduling provider panel hearings; drafting provider appeals resolution letters; monitoring and maintaining accurate appeals policies and procedures based on legal requirements; reporting and maintaining provider appeals statistics; and prepping provider appeals exhibits for Contested Case Hearings.

On a typical day, you might:

• Ensure notification letters are updated and sent to the provider accurately and timely based on the most current formats and timelines as established by State and Federal regulations.
• Follow through tracking appeal requests and setting up internal appeals panels, when needed.
• Coordinate Trillium provider appeals requests.
• Track and report appeal requests data
• This position will also serve as a backup to the member appeals team and will be cross trained in both areas.

Employee Benefits:

Trillium knows that work/life balance is important. That’s why we offer our employees competitive benefits and flexibility that is second to none. Take a look at what we have to offer:

• Typical working hours are 8:30am-5pm

• A remote work option available for most positions
• Health Insurance - no premium for employee coverage
• Flexible Spending Accounts
• Paid Time Off (PTO) of 24 days, plus 12 paid holidays within first year of employment
• NC Local Government retirement pension. This is a defined-benefit retirement plan that will pay you a monthly amount upon retirement, for the rest of your life, with as little as five years of service. For more information, go to: https://files.nc.gov/retire/documents/files/Actives/LGERSHandbook.pdf
• 401k with 5% employer match & immediate vesting
• Public Service Loan Forgiveness Qualifying Employer

Qualifications:

Education/Experience:

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 higher education/experience.

Preferred Education:

A degree in the Human Services field is preferred.

Preferred Experience:

Experience in the public mental health field is highly desired due to the complexity of the work of the organization.

License/Certification:
Must have a valid driver’s license

Location:
Remote within North Carolina.

Must reside in NC to be considered for remote status.

Deadline for application: Friday June 6th, 2025. 11:59pm.

To be considered for employment, all candidates are required to submit an application through ADP and upload a current resume. Your resume must provide your level of education and detailed work experience, including:

• Employer Name
• Dates of service (month & year)
• Average number of hours worked per week
• Essential duties of the job as related to the position you’re applying for
• Education
• Degree type
• Date degree was awarded
• Institution
• Licensure/certification, if applicable

After submitting your application through our career center in ADP, your resume will be reviewed to ensure that your skills and experience meet the essential criteria for the role you have applied for.

You will be notified by HR on the status of your application as appropriate. All applicants will receive a final email when the recruitment cycle for the position has closed.

Join our Talent Community through our ADP career center to stay informed about positions you may qualify for. Remember to keep an update resume in the Talent Community profile.

The diversity of the communities we serve is reflected in our employees. Trillium Health Resources is an Equal Employment Opportunity (EEO) employer.

Trillium Health Resources is a drug-free workplace. Candidates are required to pass a drug test as a condition of employment.

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