Remote Claims Auditor: Medicaid & MCO Adjudication

Trillium Health Resources; Clayton (NC); Remote; USD 52,000 - 64,000; Full time

Benefits offered by this job

Work-from-home options

Health Insurance with no premium for员工

Flexible Spending Accounts

24 days PTO + 12 holidays

NC Local Government Retirement Pension

401k with employer match

Remote work supplies stipend

Job summary

Trillium Health Resources is hiring a Claims Specialist II to perform data analysis, auditing and finalize adjudication results for claims under NC Medicaid guidelines. The role supports providers by phone or email and coordinates with internal and external stakeholders to resolve claims efficiently.

The person will review claim submissions, attachments, and potential errors, ensuring accuracy and compliance with CMS and NC Medicaid policies, while providing guidance and training as needed.

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 with Managed Care billing software.
• Certification CPC, CPB, CMRS or similar preferred.

Responsibilities

• Analyze and audit claims adjudication results to ensure accuracy per NC Medicaid guidelines.
• Analyze and audit claim attachments/medical documentation for adjudication.
• Identify adjudication errors and provider billing errors; escalate as needed.
• Provide training and technical assistance to provider agencies based on audit findings.

Skills

Claims processing

Data analysis

Auditing

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 hiring a Claims Specialist II to perform data analysis, auditing and finalize adjudication results for claims under NC Medicaid guidelines. The role supports providers by phone or email and coordinates with internal and external stakeholders to resolve claims efficiently.

The person will review claim submissions, attachments, and potential errors, ensuring accuracy and compliance with CMS and NC Medicaid policies, while providing guidance and training as needed.