Remote Claims Auditor II – NC Medicaid & Billing

Trillium Health Resources; Clayton (NC); Remote; USD 52,000 - 68,000; Full time

Benefits offered by this job

Work-from-home options

Health Insurance with no premium for 


Flexible Spending Accounts

24 days of Paid Time Off (PTO) plus 12

Job summary

Trillium Health Resources is seeking a Claims Specialist II to analyze and audit claims adjudication for NC Medicaid and CMS guidelines. The role supports providers by phone or email with claims questions and collaborates with internal and external stakeholders to resolve claims efficiently.

Responsibilities include auditing submissions and documentation, identifying errors, and applying departmental policies.

Qualifications

• High School Diploma or GED and two years of experience in claims processing, billing, or medical coding.
• Associate's degree in Healthcare Administration, Business, or a Human Services field.
• Hospital claims experience and knowledge.
• Experience in physical health claims processing or medical coding.
• Experience working with Managed Care billing software.
• Certification CPC, CPB, CMRS or similar preferred.

Responsibilities

• Analyze and audit claims adjudication results to determine accuracy per NC Medicaid guidelines.
• Analyze and audit attachments/medical documentation for adjudication.
• Address adjudication delays due to rejection errors.
• Identify adjudication and provider billing errors requiring action.
• Review trainings and policies to ensure correct actions in claims systems.
• Provide training and technical assistance to provider agencies.

Skills

Claims processing

Billing

Medical coding

Education

High School Diploma or GED

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

Tools

Managed Care billing software

Job description

Trillium Health Resources is seeking a Claims Specialist II to analyze and audit claims adjudication for NC Medicaid and CMS guidelines. The role supports providers by phone or email with claims questions and collaborates with internal and external stakeholders to resolve claims efficiently.

Responsibilities include auditing submissions and documentation, identifying errors, and applying departmental policies.