Claims Relations Coordinator

Get AI-powered advice on this job and more exclusive features. Trillium Health Resources provided pay range This range is provided by Trillium Health Resources. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more. Base pay range $54,106.00/yr - $68,173.00/yr Direct message the job poster from Trillium Health Resources Pay Plan Title: Coordinator Working Title: Claims Relations Coordinator Cost Center: 4300/Claims Position Number: 91014 FLSA Status: Exempt Posting Salary Range: $54,106 - $68,173 Office Location: Remote within North Carolina POSTING DETAILS: Make an Impact Trillium Health Resources is a Tailored Plan and Managed Care Organization (MCO) serving 46 counties across North Carolina. We manage services for individuals with serious mental health needs, substance use disorders, traumatic brain injuries, and intellectual/development (IDD) disabilities. Our mission is to help individuals and families build strong foundations for healthy, fulfilling lives. Why Work for Us ? Trillium believes that empowering others begins with supporting our team. We offer our employees: Competitive benefits and work-from-home options for most positions Opportunities for professional growth in a diverse inclusive culture Every day, our work changes lives – from children thriving through early intervention and school-based therapies, to adults with severe mental illness living independently and contributing to their communities. If you are looking for a unique opportunity to make a tangible impact on the lives of others, apply today! What We’re Looking For Trillium Health Resources has a career opening for a Claims Relations Coordinator to join our Claims team. The primary responsibilities in this role include managing and coordinating claim issues received by providers, members, or other entities via telephone call, email, and ticket system. The coordination of claim issues includes providing support and information to the provider community. This position will research and gather necessary information regarding claim issues and relay the resolution and/or summary of these issues to the provider community. This position will also be responsible for tracking, reviewing, and coordinating timely and accurate responses that may include inquiries, claims issues, and escalations submitted by the State Department. On a typical day, you might: Coordination and management of Claims Department Claims Relations Process. Ensure claims ticket queue and call logs are updated and responded to timely to allow for timely notifications to the provider community on the resolution and/or summary of their issues. Conduct claims research, including, but not limited to, review of claims processing system, review of previous and current tickets in the Claims Support Queue, review of paper claim logs, working with other claims staff to learn history, third party biller impacts, Remittance Advice notifications and provider technical assistance. Review trends of provider issues and make recommendations for updates needed in the Claims Processing System and Claims Staff training. Coordination and management of calls and tickets. Employee Benefits: Trillium knows that work/life balance is essential. That’s why we offer: Typical working hours: 8:30 am – 5:00 pm Work-from-home options available for most positions Health Insurance with no premium for employee coverage Flexible Spending Accounts 24 days of Paid Time Off (PTO) plus 12 paid holidays in your first year 401k with 5% employer match and immediate vesting Public Service Loan Forgiveness (PSLF) qualifying employer Quarterly stipend for remote work supplies Qualifications Required: High School diploma/GED with a minimum of six (6) years of experience in coordinating multiple deadlines, drafting and reviewing written correspondence, and maintaining files and/or research in a healthcare or public health setting which includes a minimum of six (6) years of extensive medical claims research including reviewing denials, member eligibility, communicating both written and verbally with the provider community, and analyzing claim reports; OR Associate’s degree with a minimum of four (4) years of experience in coordinating multiple deadlines, drafting and reviewing written correspondence, and maintaining files and/or research in a healthcare or public health setting which includes a minimum of four (4) years of extensive medical claims research including reviewing denials, member eligibility, communicating both written and verbally with the provider community, and analyzing claim reports; OR Bachelor’s degree with a minimum of two (2) years of experience in coordinating multiple deadlines, drafting and reviewing written correspondence, and maintaining files and/or research in a healthcare or public health setting which includes a minimum of two (2) years of extensive medical claims research including reviewing denials, member eligibility, communicating both written and verbally with the provider community, and analyzing claim reports; OR Equivalent combination of education/experience. Must have a valid driver’s license Must reside within North Carolina. Must be able to travel within catchment as required. Preferred: Degree in Business Administration, Healthcare Administration, Human services, Public Administration, Liberal Arts, or Humanities. Experience in the public mental health field is highly desired due to the complexity of the work of organization. Deadline for Application: January 7,View email address on click.appcast.io:59pm How to Apply To be considered, submit your application and resume through our ADP Career Center. Your resume must include: Employer name, dates of service (month/year), average hours worked per week, and essential job duties Education details (degree type, date awarded, institution, field of study) Licensure/certification information, if applicable After submission, your resume will be reviewed to ensure it meets the essential criteria for the position. You’ll be notified by HR regarding your application status as appropriate. All applicants will receive a final update once the recruitment cycle closes. Join our Talent Community through ADP to stay informed about future opportunities. Be sure to keep your resume updated in your profile. Trillium Health Resources is an Equal Employment Opportunity (EEO) employer and a drug-free workplace. All candidates must pass a drug test as a condition of employment. #Innovation #Technology #Careers #NorthCarolina #BehavioralHealth #J-18808-Ljbffr