Appeals Specialist II
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Job Description
Appeals Specialist managing behavioral-health grievances for Trillium Health Resources, a North Carolina managed-care organization. Investigating cases, determining resolutions, and issuing compliant communications.
Responsibilities:
- Manage assigned appeals, grievances, and/or complaint cases from intake through resolution.
- Investigate cases by gathering documentation, interviewing stakeholders, and analyzing findings.
- Evaluate case information to determine appropriate resolution and required actions.
- Prepare and issue acknowledgment and resolution letters within required time frames.
- Maintain complete case files in accordance with regulatory and accreditation standards.
- Ensure accurate, timely resolution and compliance with regulatory and accreditation requirements.
Requirements:
- High school diploma or GED and six (6) years of experience in the Mental Health, Developmental Disabilities, and Substance Use services field; OR Associate's degree and four (4) years of experience in the Mental Health, Developmental Disabilities, and Substance Use services field; OR Bachelor's degree and two (2) years of experience in the Mental Health, Developmental Disabilities, and Substance Use services field; OR Equivalent combination of education and experience.
- Must have a valid driver’s license.
- Must reside within North Carolina.
- Must be able to travel within catchment as required.
- Preferred: Experience working with provider claims, provider network, or provider sanctions.
- All candidates must pass a drug test as a condition of employment.
Benefits:
- A collaborative, mission-driven work environment
- Competitive benefits
- Work-from-home options available for most positions
- Opportunities for professional growth in a diverse inclusive culture
- Flexible work schedules with some roles with management approval
- 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
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