Claims Director

Pay Plan Title: Unit Director

Working Title: Claims Director

FLSA Status: Exempt

Posting Salary Range: $87,652 - $117,232

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:

• A collaborative, mission-driven work environment
• 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 Director to join our team! This position provides leadership and management for the Claims staff, in the Claims Department, as applicable. The Claims Director is responsible for the processing of all claims, the data elements required to process claims, in addition to the reporting and analysis of claims data. Position is responsible for identification of Medicaid and State Funded services (fee-for-service and Medicaid Waiver services) including retroactive Medicaid coverage for paid claims. This position may interact with the provider community to address specific billing issues as well as other stakeholders including but not limited to the Department of Health and Human Services. Position is responsible for training staff on claims processing and reporting and analysts’ duties. Position is also required to work closely with other leadership members. This position requires knowledge of the operating claims system, accounting system, data reporting, and overall claims processing and financial analysis operations.

On a typical day, you might:

• Provide leadership, direction and management of the department
• Gather, research and analyze various data to aid Executive Management in decisions regarding provider services
• Ensure the identification of Medicaid and state funded covered services including retroactive Medicaid coverage to ensure appropriate enrollment and claims payment
• Interact with providers and department staff to address any enrollment, payment and billing issues
• Assist in ensuring that reimbursement tables in the claim’s software remain current
• Develop and implement solutions for claims management

Employee Benefits:

Trillium knows that work/life balance is essential. That’s why we offer:

• Typical working hours: 8:30 am – 5:00 pm; flexible work schedules with some roles with management approval.
• 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
• 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

Qualifications

Required:

• Bachelor’s degree and three (3) years’ experience with extensive medical claims filing, coding, data reporting, and financial analysis. Knowledge of Professional (Form CMS1500) Institutional (UB04) billing form, ICD-10/CPT/HCPCS coding/CAQH, HIPAA and claims processing.

• 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 field and/or Master’s degree
• Supervision of two (2) or more employees
• Experience with NC Medicaid
• One or more of the following: Certified Professional Coder (CPC), Certified Coding Associate (CCA), Certified Outpatient Coder (COC) & Certified Inpatient Coder (CIC), Certified Risk Adjustment Coder (CRC), Certified Coding Specialist (CCS)

Deadline for Application: June 4th at 11:59pm

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.

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