Remote Claims Specialist II – Medicaid Billing & Audits

Trillium Health Resources; North Carolina; Remote; USD 52,000 - 78,000; Full time

Benefits offered by this job

Work-from-home options

Health Insurance with no premium for员工

Flexible Spending Accounts

24 days of PTO + 12 holidays

NC Local Government Retirement Pension

401k with 5% employer match

Remote work stipend

Job summary

Trillium Health Resources is seeking a Claims Specialist II to perform data analysis, auditing, and adjudication finalization for pre- and post-payment reviews in NC Medicaid and Trillium policies. You will assist providers by phone or email with claims processing questions and coordinate with stakeholders to resolve claims efficiently.

Ideal candidates have 2+ years in claims processing or medical coding, experience with managed care billing software, and a diploma or degree in healthcare

Qualifications

• 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.
• Certifications such as CPC/CPB/CMRS are preferred.

Responsibilities

• Analyze and audit claims adjudication results for NC Medicaid guidelines.
• Audit claim attachments/medical documentation to adjudicate accurately.
• Review adjudication delays due to rejection errors and take corrective actions.
• Identify adjudication errors and provider billing issues for resolution.
• Ensure systems reflect required actions per trainings and policy documents.
• Provide training and technical assistance to provider agencies on submission guidelines and denial management.
• Communicate with providers and internal/external stakeholders to facilitate resolution.
• Support flexible work schedules with management approval.

Skills

Data analysis

Auditing

Claims processing

Education

High School Diploma or GED

Associate's degree in Healthcare Administration, Business, or Human Services

Tools

Managed Care billing software

Job description

Trillium Health Resources is seeking a Claims Specialist II to perform data analysis, auditing, and adjudication finalization for pre- and post-payment reviews in NC Medicaid and Trillium policies. You will assist providers by phone or email with claims processing questions and coordinate with stakeholders to resolve claims efficiently.

Ideal candidates have 2+ years in claims processing or medical coding, experience with managed care billing software, and a diploma or degree in healthcare