Remote Claims Analyst — Risk & Adjudication

Trillium Health Resources; Charlotte (NC); Remote; USD 52,000 - 75,000; Full time

Benefits offered by this job

Work-from-home options

Health Insurance

Flexible Spending Accounts

Paid Time Off

Retirement benefits

401k with employer match

Job summary

Trillium Health Resources in North Carolina is hiring a Claims Specialist II to perform data analysis, auditing and adjudication of claims for NC Medicaid and CMS guidelines. You will assist providers by phone or email and coordinate with internal and external stakeholders to facilitate timely, accurate claims resolution.

Qualifications include a High School diploma or GED with two years in claims processing or medical coding; an Associate's degree in Healthcare Administration, Business or Human

Qualifications

• High school diploma or GED required, plus two years in claims processing, billing, or medical coding.
• Associate's degree in Healthcare Administration, Business, or Human Services preferred.
• Hospital claims experience and knowledge of NC Medicaid.
• Experience with managed care billing software preferred.
• Certifications CPC/CPB/CMRS or equivalent preferred.

Responsibilities

• Analyze and audit claims adjudication results for NC Medicaid compliance.
• Audit attachments and medical documentation for adjudication.
• Identify errors and take corrective actions to resolve delays.
• Provide training and technical assistance to providers.
• Communicate with internal and external stakeholders to facilitate claims resolution.
• Adhere to CMS and Trillium policies and procedures.

Skills

Data analysis

Auditing

Claims processing

Billing

Medical coding

Communication

Education

High School Diploma or GED

Associate's degree in Healthcare Admin/Business/Human Services

Job description

Trillium Health Resources in North Carolina is hiring a Claims Specialist II to perform data analysis, auditing and adjudication of claims for NC Medicaid and CMS guidelines. You will assist providers by phone or email and coordinate with internal and external stakeholders to facilitate timely, accurate claims resolution.

Qualifications include a High School diploma or GED with two years in claims processing or medical coding; an Associate's degree in Healthcare Administration, Business or Human