[Remote] Prepayment Review Clinician
Note: The job is a remote job and is open to candidates in USA. Trillium Health Resources is a Managed Care Organization serving individuals with serious mental health needs and disabilities across North Carolina. They are seeking a Prepayment Review Clinician responsible for ensuring compliance with Federal, State, and Accreditation requirements through internal and external reviews of provider claims.
Responsibilities
- Conduct clinical portions of the Prepayment Claims Review to ensure provider network and agency compliance with applicable laws and regulations prior to payment
- Ensure all timeframes associated with Prepayment Claims review are identified, monitored and met by team throughout process
- Provide appropriate communication, both verbally and written, throughout Prepayment Claims Review process with internal departments and external agencies, as appropriate
- Assist with tracking logs related to Prepayment Claims Reviews
- Maintain all documentation related to Prepayment Claims Review activities
Skills
- Master's degree
- Minimum one (1) year of experience with behavioral health, mental health, substance abuse, developmental disabilities and/or co-occurring disorders populations or field
- Fully licensed by the State of North Carolina as a LCMHC, LMFT, LCSW, LCAS, or RN
- Must have a valid driver's license
- Must reside within North Carolina
- Must be able to travel within catchment as required
- Experience in any of the following areas: healthcare compliance, knowledge of North Carolina Clinical Coverage Policies and billing requirements related to Medicaid, knowledge and understanding of Prepayment Review Process, public speaking, mediation and/or problem resolution, group facilitation, advocacy, and project management
- Certified in Healthcare Compliance (CHC), Accredited Health Care Fraud Investigator (AFHI), Certified Fraud Examiner (CFE), or equivalent certifications
Benefits
- 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 Overview