Remote Claims Analyst II - Auditing & Resolution

Trillium Health Resources; North Carolina; On-site; USD 43,000 - 62,000; Full time

Benefits offered by this job

Health Insurance with no premium for员工

Flexible Spending Accounts

PTO and paid holidays

NC Local Government Retirement Pension

401k with 5% employer match

Public Service Loan Forgiveness

Remote work stipend

Job summary

Trillium Health Resources is seeking a Claims Specialist II to join our North Carolina team. The role performs data analysis, auditing, and finalizes adjudication results for pre-payment and post-payment review of claim adjudication per CMS, NC Medicaid, and Trillium policies.

The person will assist providers by phone or email with claims processing questions and coordinate with internal and external stakeholders to facilitate efficient resolution.

Qualifications

• Must have 2+ years of experience in claims processing, billing or medical coding.
• Must reside within North Carolina and have a valid driver’s license.
• Travel within catchment as required.

Responsibilities

• Analyze and audit claims adjudication results to ensure NC Medicaid guidelines are followed.
• Analyze and audit claim attachments/medical documentation for adjudication.
• Review and act on delayed adjudication due to rejection errors.
• Identify adjudication errors and provider billing issues needing technical assistance.
• Ensure claims system and processes reflect required actions per trainings and policy documents.
• Provide training and technical assistance to provider agencies on submission guidelines and denial management.
• Report suspected system issues to supervisor based on data analysis.

Skills

Claims processing

Billing

Medical coding

Education

High School Diploma/GED

Associate’s degree preferred

Job description

Trillium Health Resources is seeking a Claims Specialist II to join our North Carolina team. The role performs data analysis, auditing, and finalizes adjudication results for pre-payment and post-payment review of claim adjudication per CMS, NC Medicaid, and Trillium policies.

The person will assist providers by phone or email with claims processing questions and coordinate with internal and external stakeholders to facilitate efficient resolution.