[Hiring] Member & Recipient Appeals Coordinator @TRILLIUM HEALTH RESOURCES

Role Description

The Member & Recipient Appeals Coordinator is responsible for managing and coordinating the Trillium Medicaid and Non-Medicaid member appeals process, provider appeals, and claims appeals. This includes:

• Providing support and information to members and providers seeking to appeal an adverse benefit determination.
• Monitoring and maintaining accurate Appeals policies and procedures, member handbooks, and provider manuals based on legal requirements and Tailored Plan requirements.
• Maintaining/reporting Medicaid and non-Medicaid member appeal statistics.

On a typical day, you might:

• Coordinate and manage Trillium’s Medicaid and Non-Medicaid Member Appeal Processes.
• Ensure notification letters are updated and sent to the member/guardian and provider accurately and timely based on the most current formats and timelines as established by State and Federal regulations and contractual and accreditation standards.
• Track appeal requests and set up internal appeals panels, when needed.
• Aid general counsel and external contracted legal representatives in preparation for Trillium-specific Appeals related cases.
• Assist in completion of data reports.

Qualifications

• High School Diploma/GED and six (6) years of experience in Behavioral/Mental Health, Developmental Disabilities, and Substance Abuse services; OR
• Associate’s degree and four (4) years of experience in Behavioral/Mental Health, Developmental Disabilities, and Substance Abuse services; OR
• Bachelor’s degree and two (2) years of experience in Behavioral/Mental Health, Developmental Disabilities, and Substance Abuse services; 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.
• Degree in a Human Services field (preferred).
• Experience in the public mental health field is highly desired due to the complexity of the work of the organization (preferred).

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.

Company Description

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.