Jobs at Trillium Health Resources

Analyze and reconcile provider claims payments, credit memos, recoupments, levies and payment adjustments. Validate payment files (EFT/835/RA), prepare financial reports and reconciliations, research discrepancies, support audits, test system enhancements, and develop reporting tools while collaborating with Claims, IT, Provider Relations, and Finance to ensure accurate, compliant provider payment processing.

Manage administrative components of clinical review for IDD and behavioral health service authorization requests. Pre-screen submissions for completeness and policy compliance, track review timelines and outcomes, coordinate documentation with UM clinicians, communicate decisions to providers, and ensure timely issuance of required notices and actions.

Manage administrative components of behavioral health/substance-use service authorization reviews: pre-screen requests for completeness and policy compliance, coordinate documentation and clinician reviews, track timelines and outcomes, communicate decisions to providers, and ensure required notices are issued on time.

Coordinate and lead network development projects to build qualified service provider networks; manage project plans, timelines, stakeholder communications, dashboards/Smartsheet reporting, provider recruitment, and RFP/RFA/RFI processes to improve network capacity, access, cultural competency, and quality.

Provide clinical review and authorization decisions for members with mental health, substance use, and developmental disabilities; perform triage, care coordination, consultation to providers, and documentation of medical necessity and levels of care.

Manage provider network quality and compliance for mental health, developmental disability, and substance use services. Conduct objective audits, monitor corrective action plans, provide technical assistance to providers, ensure adherence to federal, state, and accreditation standards, and maintain inter-rater reliability in reviews.

Develop and maintain IT business systems including web applications and UIs. Design and optimize relational databases, write complex SQL queries, stored procedures and triggers, perform query optimization and tuning, integrate databases with applications and reporting tools, and support/enhance existing business applications and long-range system planning.

Manage the business systems product backlog and lead Product Services and Project Services teams. Use Agile Scrum to drive development, facilitate ceremonies, prioritize work, evaluate team performance, and contribute to systems design, configuration, and implementation to meet organizational needs.

Provide financial analysis and auditing support by preparing and reviewing journal entries, accruals, and reconciliations; build forecasting and financial models; prepare monthly expense summaries, financial reports, and presentations; compile and analyze financial statements to support business planning and decision-making.

Manage the applications product backlog and prioritize user stories; lead Product Services and Project Services teams; drive Agile Scrum development, facilitate ceremonies, evaluate team technical performance, and contribute to business systems architecture, design, configuration, and delivery of IT solutions.

Manage user account lifecycle and access controls, implement and support IAM technologies and RBAC strategies, lead small-to-medium IAM projects, develop access/security implementation plans, support provisioning and role management, and assist staff and leadership with IAM-related requests and continuous improvement.

Provide clinical pharmacy support for a managed care organization: help develop and implement pharmacy programs, perform medication reconciliation and management referrals, manage formulary and utilization programs, conduct provider/member education and outreach, support pharmacy team projects, and participate in multidisciplinary case reviews.

Manage and coordinate provider and member claim issues via phone, email, and ticketing. Research claims (denials, eligibility, remittance), update claim queues and logs, draft provider communications, track escalations, and recommend system or staff training updates to improve claims processing.

The IDD Monitoring Coordinator ensures compliance with HCBS requirements, monitors services for individuals with intellectual disabilities, and conducts assessments and communication to promote service satisfaction.