Trillium Health Resources · 8 hours ago
Prepayment Review Clinician
United States
Full-time
Remote
Entry Level
$66K/yr - $89K/yr
1+ years expTrillium Health Resources is a Tailored Plan and Managed Care Organization serving 46 counties across North Carolina. The Prepayment Review Clinician is responsible for ensuring compliance with Federal, State, and Accreditation requirements through internal and external reviews, particularly focusing on the Prepayment Claims Review process.
Child CareHealth CareMental HealthNon Profit
No H1B
Responsibilities
Conduct clinical portions of the Prepayment Claims Review to ensure provider network and agency compliance with applicable laws and regulations prior to payment
Ensure all timeframes associated with Prepayment Claims review are identified, monitored and met by team throughout process
Provide appropriate communication, both verbally and written, throughout Prepayment Claims Review process with internal departments and external agencies, as appropriate
Assist with tracking logs related to Prepayment Claims Reviews
Maintain all documentation related to Prepayment Claims Review activities
Qualification
Required
Master's degree
Minimum one (1) year of experience with behavioral health, mental health, substance abuse, developmental disabilities and/or co-occurring disorders populations
Fully licensed by the State of North Carolina as a LCMHC, LMFT, LCSW, LCAS, or RN
Must have a valid driver's license
Must reside within North Carolina
Must be able to travel within catchment as required
Preferred
Experience in any of the following areas: healthcare compliance, knowledge of North Carolina Clinical Coverage Policies and billing requirements related to Medicaid, knowledge and understanding of Prepayment Review Process, public speaking, mediation and/or problem resolution, group facilitation, advocacy, and project management
Certified in Healthcare Compliance (CHC), Accredited Health Care Fraud Investigator (AFHI), Certified Fraud Examiner (CFE), or equivalent certifications
Benefits
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
NC Local Government Retirement Pension (defined-benefit plan)
401k with 5% employer match and immediate vesting
Public Service Loan Forgiveness (PSLF) qualifying employer
Quarterly stipend for remote work supplies
Company
Trillium Health Resources
Trillium Health Resources is a local governmental agency for individuals with serious mental health, and intellectual disability services.
Founded in 1972Greenville, North Carolina, USA
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Joy Futrell
Chief Executive Officer
Cindy Ehlers MS LCMHC
Chief Operating Officer
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