[Hiring] Claims Relations Coordinator @TRILLIUM HEALTH RESOURCES

Role Description

The Claims Relations Coordinator is responsible for 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. The Claims Relations Coordinator 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:

• Coordinate and manage calls and tickets.
• 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
  • Provider technical assistance
• Assist with drafting provider related communications.
• Review trends of provider issues and make recommendations for updates needed in the Claims Processing System and Claims Staff training.

Qualifications

• 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.

Requirements

• Degree in Business Administration, Healthcare Administration, Human Services, Public Administration, Liberal Arts, or Humanities (preferred).
• Experience in the public mental health field is highly desired due to the complexity of the work of organization.

Benefits

• 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.