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) https://www.myncretirement.gov/systems-funds/local-governmental-employees-retirement-system-lgers/lgers-handbook
- 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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Skills Required
- Bachelor's degree
- three years' experience with medical claims filing, coding, data reporting, and financial analysis
- Knowledge of billing forms and coding
- Valid driver's license
- Reside within North Carolina
- Ability to travel within catchment
- Degree in Business or Master's degree
- Supervision of two or more employees
- Experience with NC Medicaid
- Professional coding certification(s)
What We Do
Trillium Health Resources manages specialty behavioral health care for North Carolinians across 46 counties. Trillium is committed to transforming lives and building community well-being through partnership, access to services and proven solutions designed to help those we serve reach their fullest potential. Everyone on Trillium’s staff--our care managers, call center, claims agents, project managers, and IT staff--all contribute to this mission. We offer a challenging, engaging work environment where staff take home more than a paycheck. Our performance management plan includes regular check-ins to examine individual employee goals and professional development plan. Our departments work on cross-functional, short-term projects and long ranging initiatives. Every day we see the results of our dedication, in the smiles of children on our accessible playgrounds and pride on the face of an adult cooking a meal for the first time. By joining Trillium, you are doing more than going to work…you are transforming lives. We help those with mental health conditions, intellectual and developmental disabilities, traumatic brain injury, and substance use disorders (Medicaid members and state-funded recipients) get the services they need to improve well-being and live fulfilling lives. We are dedicated to carrying out our mission by investing in the health and well-being of the communities we serve and empowering individuals with access to services, tools and resources to live a fulfilling life. Trillium reserves the right to hide material (comments, images and/or links to other sites) that contains anything vulgar or sexually explicit; is spam; advocates or depicts illegal activity; targets or disparages any ethnic, racial, other type of group; contains personal attacks of any kind; promotes private business ventures, services, or products; campaigns for public office or promotes a political organization; infringes on copyrights or trademarks; or is off topic.
