Senior Claims Specialist

Trillium Health Resources; United States; Remote; USD 40,000 - 64,000; Full time

Job summary

An established industry player is seeking a Senior Claims Specialist to join their dynamic Claims Team. This role involves analyzing and auditing claims, ensuring compliance with Medicaid guidelines, and providing essential support to providers. The position offers the flexibility of remote work within North Carolina and emphasizes a strong commitment to employee well-being and professional development. Join a workplace where your contributions directly impact the community and help individuals lead healthier lives. If you're passionate about making a difference and have a background in claims processing, this opportunity is perfect for you.

Benefits

Health Insurance - no premium for employee coverage

Flexible Spending Accounts

Paid Time Off (PTO) of 24 days

12 paid holidays

401k with 5% employer match

Public Service Loan Forgiveness Qualifying Employer

Remote work option

Qualifications

• 2 years experience in claims processing or billing.
• Knowledge of NC Medicaid guidelines and auditing processes.

Responsibilities

• Analyze and audit claims for accuracy and compliance.
• Provide training and technical assistance to providers.

Skills

Claims Processing

Auditing

Data Analysis

Technical Assistance

Education

High School Diploma or GED

Associate’s degree in Healthcare Administration

Tools

Managed Care Billing Software

Job description

Pay Plan Title:Data Analyst

Working Title: Senior Claims Specialist

Position Number: 45062

FLSA Status: Non-Exempt

Posting Salary Range:$40,314 - $63,217

Office Location: Remote within North Carolina.

POSTING DETAILS:

Make an Impact

Trillium Health Resources is a local governmental agency (LME/MCO) in North Carolina that manages serious mental health, substance use, and intellectual/developmental disability services. Serving in 46 counties, we help individuals and their families strengthen well-being and build foundations for a healthy life.

Join our team as we empower others to live their best lives by providing access to quality healthcare. We offer a challenging, engaging work environment where staff take home more than a paycheck. Every day, we see the results of our dedication – in the smiles of children on our accessible playgrounds and in the pride on the face of an adult cooking a meal for the first time. Working at Trillium Health Resources is more than just a job; it is an opportunity to make a direct impact on the communities we serve.

At Trillium, we know that empowering others begins with supporting and developing our team. That’s why we offer competitive benefits and work-from-home flexibility so that our employees thrive outside of the office. We’re also committed to building a diverse, inclusive culture where all employees have the potential to grow professionally and personally.

What We’re Looking For

Trillium Health Resources has career opening for Senior Claims Specialist to join our Claims Team. This position performs analysis, reconciliation, auditing, monitoring and reporting functions within the Claims Department. The Senior Claims Specialist will assist providers by phone or email with claims processing questions and communicate with internal and external stakeholders to facilitate efficient claims resolution. Don’t miss this opportunity and apply today!

On a typical day, you might:

• 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.
  

Employee Benefits:

Trillium knows that work/life balance is important. That’s why we offer our employees competitive benefits and flexibility that is second to none. Take a look at what we have to offer:

• Typical working hours are 8:30am-5pm

• A remote work option available for most positions
• Health Insurance - no premium for employee coverage
• Flexible Spending Accounts
• Paid Time Off (PTO) of 24 days, plus 12 paid holidays within first year of employment
• NC Local Government retirement pension. This is a defined-benefit retirement plan that will pay you a monthly amount upon retirement, for the rest of your life, with as little as five years of service. For more information, go to: https://files.nc.gov/retire/documents/files/Actives/LGERSHandbook.pdf
• 401k with 5% employer match & immediate vesting
• Public Service Loan Forgiveness Qualifying Employer

Qualifications:

Required Education:
High School Diploma or GED.

Preferred Education:
Associate’s degree in Healthcare Administration, Business, or a Human Services field (such as Psychology, Social Work, etc.) preferred

Required Experience:
Two (2) years of experience in the claims processing or billing or medical coding field.

OR

Equivalent combination of education/experience.

Preferred Experience:
Experience in the areas of physical health claims processing or medical coding preferred.

Experience in working with Managed Care billing software preferred.

Required License/Certification:

Must have a valid driver’s license

Preferred License/Certification:
Certified Professional Coder (CPC), Certified Professional Biller (CPB), Certified Medical Reimbursement Specialist (CMRS) or similar certification preferred.

Location:
Remote within North Carolina.
Must reside in North Carolina to be considered for remote status.

Deadline for application: Wednesday, May 14, 2025 at 11:59pm

To be considered for employment, all candidates are required to submit an application through ADP and upload a current resume. Your resume must provide your level of education and detailed work experience, including:

• Employer Name
• Dates of service (month & year)
• Average number of hours worked per week
• Essential duties of the job as related to the position you’re applying for
• Education
• Degree type
• Date degree was awarded
• Institution
• Licensure/certification, if applicable

After submitting your application through our career center in ADP, your resume will be reviewed to ensure that your skills and experience meet the essential criteria for the role you have applied for.

You will be notified by HR on the status of your application as appropriate. All applicants will receive a final email when the recruitment cycle for the position has closed.

Join our Talent Community through our ADP career center to stay informed about positions you may qualify for. Remember to keep an update resume in the Talent Community profile.

The diversity of the communities we serve is reflected in our employees. Trillium Health Resources is an Equal Employment Opportunity (EEO) employer.

Trillium Health Resources is a drug-free workplace. Candidates are required to pass a drug test as a condition of employment.

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