Member and Recipient Appeals Coordinator

Pay Plan Title: Coordinator

Working Title: Member and Recipient Appeals Coordinator

FLSA Status: Exempt

Posting Salary Range: $53,045 - $66,837

Office Location: Remote in North Carolina                            

POSTING DETAILS:

Make an Impact  

Trillium Health Resources is a local governmental agency (LME/MCO) in North Carolina that manages serious mental health, substance use, and intellectual/developmental disability services. Serving in 46 counties, we help individuals and their families strengthen well-being and build foundations for a healthy life.

Join our team as we empower others to live their best lives by providing access to quality healthcare. We offer a challenging, engaging work environment where staff take home more than a paycheck. Every day, we see the results of our dedication – in the smiles of children on our accessible playgrounds and in the pride on the face of an adult cooking a meal for the first time. Working at Trillium Health Resources is more than just a job; it is an opportunity to make a direct impact on the communities we serve.

At Trillium, we know that empowering others begins with supporting and developing our team. That’s why we offer competitive benefits and work-from-home flexibility so that our employees thrive outside of the office. We’re also committed to building a diverse, inclusive culture where all employees have the potential to grow professionally and personally.

What We’re Looking For:

We are seeking an organized and detail-oriented Appeals Coordinator to manage and coordinate all aspects of member and recipient appeals, including adverse benefit determination appeals and complaint/grievance appeals. This position will play a critical role in ensuring that all parties involved receive the necessary support and information throughout the process, maintaining compliance with legal and Tailored plan requirements, and contributing to ongoing improvements in the appeals process.

On a typical day, you might:

• Coordinate and manage Trillium’s Medicaid and Non-Medicaid Member Appeal Processes. 
• Ensure notification letters are updated and sent to the member/ guardian and provider, as applicable. 
• Assist with updating and completing adverse benefit notification letters, as needed. 
• Comply with all required timelines, accreditation standards, and NC DHHS contract requirements.
• Track appeal requests. 
•  Arrange initial appeal reviews.
• Facilitate mediations and arrange State Fair Hearings. 
•  Track and report member appeals data. 
• Research legal and contractual requirements to assist with appeals resolutions as needed by Trillium’s legal team

Employee Benefits:

Trillium knows that work/life balance is important. That’s why we offer our employees competitive benefits and flexibility that is second to none. Take a look at what we have to offer:

• A remote work option available for most positions
• Health Insurance - no premium for employee coverage
• Flexible Spending Accounts
• Paid Time Off (PTO) of 24 days, plus 12 paid holidays within first year of employment
• NC Local Government retirement pension. This is a defined-benefit retirement plan that will pay you a monthly amount upon retirement, for the rest of your life, with as little as five years of service. For more information, go to: https://files.nc.gov/retire/documents/files/Actives/LGERSHandbook.pdf
• 401k with 5% employer match & immediate vesting
• Public Service Loan Forgiveness Qualifying Employer

Qualifications: 

Education: Associate, Bachelor

Preferred education: Bachelor’s in Human Services field

Experience:

• Associate’s degree in a Human Services field and four (4) years’ experience in Mental Health, Developmental Disabilities, and Substance Abuse services. OR
•  Bachelor’s degree in a Human Services field and two (2) years’ experience in Mental Health, Developmental Disabilities, and Substance Abuse services. OR 
• Equivalent combination of education/experience.

Preferred Experience: Experience in the public mental health field is highly desired due to the complexity of the work of the organization.

License/Certification: None Identified

Must have a valid driver’s license

Must reside in North Carolina to be considered for remote status

Deadline for application: Tuesday November 19, 2024 @ 11:59PM

To be considered for employment, all candidates are required to submit an application through ADP and upload a current resume.  Your resume must provide your level of education and detailed work experience, including: 

• Employer Name
  1. Dates of service (month & year)
  2. Average number of hours worked per week
  3. Essential duties of the job as related to the position you’re applying for
• Education
  1. Degree type
  2. Date degree was awarded
  3. Institution
• Licensure/certification, if applicable

After submitting your application through our career center in ADP, your resume will be reviewed to ensure that your skills and experience meet the essential criteria for the role you have applied for.

Join our Talent Community through our ADP career center to stay informed about positions you may qualify for. Remember to keep an update resume in the Talent Community profile. 

The diversity of the communities we serve is reflected in our employees. Trillium Health Resources is an Equal Employment Opportunity (EEO) employer.

Trillium Health Resources is a drug-free workplace. Candidates are required to pass a drug test as a condition of employment.

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