[Hiring] Provider Appeals Coordinator @TRILLIUM HEALTH RESOURCES

Role Description

Trillium Health Resources has a career opening for a Provider Appeals Coordinator to join our team! The Provider Appeals Coordinator is responsible for managing and coordinating complaints and grievance appeals, provider appeals, and claims appeals. This includes:

• Providing support and information to providers seeking to appeal an adverse Trillium action.
• Scheduling provider panel hearings, when appropriate.
• Drafting provider appeals resolution letters.
• Monitoring and maintaining accurate appeals policies and procedures based on legal requirements.
• Reporting and maintaining provider appeals statistics.
• Prepping provider appeals exhibits for Contested Case Hearings.

On a typical day, you might:

• Ensure notification letters are updated and sent to the provider accurately and timely based on the most current formats and timelines as established by State and Federal regulations.
• Track appeal requests and set up internal appeals panels, when needed.
• Coordinate Trillium provider appeals requests.
• Ensure all provider appeals files are maintained in accordance with 42CFR and contractual and accreditation standards.

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.

Requirements

• A 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.

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.