[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 Trillium Health Resources is a local governmental agency for individuals with serious mental health, and intellectual disability services. It was founded in 1972, and is headquartered in Greenville, North Carolina, USA, with a workforce of 1001-5000 employees. Its website is