Remote Medicaid Claims Auditor & Analyst

Trillium Health Resources; North Carolina; Remote; USD 52,000 - 70,000; Full time

Job summary

Trillium Health Resources seeks a Claims Specialist II to perform data analysis, auditing, and final adjudication for NC Medicaid and Trillium policies. You will assist providers by phone or email and coordinate with stakeholders to resolve claims efficiently.

The role supports remote work within North Carolina, with standard benefits and opportunities for training and professional growth. Deadline: open until filled.

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.
• Certified Professional Coder (CPC), Certified Professional Biller (CPB), CMRS or similar certification preferred.

Responsibilities

• Analyze and audit claims adjudication results to determine if claims were accurately submitted and processed according to NC Medicaid guidelines.
• Analyze and audit claim attachments/medical documentation necessary to appropriately adjudicate a claim.
• Analyze, audit and take appropriate actions for claims delayed for adjudication due to rejection errors.
• Identify adjudication errors, provider billing errors, and the need for technical assistance.
• Ensure the claims system and manual processes are incorporating required actions by reviewing and applying information from departmental trainings, published coverage policies and other NCDHHS documents.
• Provide training, education and technical assistance to provider agencies based on analysis or audit findings related to basic claim submission guidelines, denial management, system use and updates.
• Recognize and report suspected system issues or concerns to immediate supervisor for follow-up based on data analysis.
• flexible work schedules with some roles with management approval.

Skills

Claims processing

Billing

Medical coding

Education

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

Tools

Managed Care billing software

Job description

Trillium Health Resources seeks a Claims Specialist II to perform data analysis, auditing, and final adjudication for NC Medicaid and Trillium policies. You will assist providers by phone or email and coordinate with stakeholders to resolve claims efficiently.

The role supports remote work within North Carolina, with standard benefits and opportunities for training and professional growth. Deadline: open until filled.