Prepayment Review Clinician

Pay Plan Title: Clinician Working Title: Prepayment Review Clinician FLSA Status: Exempt Posting Salary Range: $66,240 - $88,595 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 Prepayment Review Clinician to join our team! The Prepayment Review Clinician is responsible for maintaining knowledge of applicable Federal, State, and Accreditation requirements and ensuring providers, vendors and Trillium maintain compliance with these requirements through internal and external reviews. On a typical day, you might: 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. 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) 401k with 5% employer match and immediate vesting Public Service Loan Forgiveness (PSLF) qualifying employer Quarterly stipend for remote work supplies Qualifications Required: 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. Preferred: 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. Deadline for Application: Monday, April 20, 2026 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. #Innovation #Technology #Careers #NorthCarolina #BehavioralHealth