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 reputed company North Carolina

POSTING DETAILS

reputed company an Impact

reputed company 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 reputed company. 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 reputed company 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 reputed company a reputed company impact on the lives of others, apply today!

reputed company’re Looking For

reputed company has a career opening for a Prepayment Review Clinician to join reputed company! 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 reputed company 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 reputed company to Prepayment Claims Reviews.
• Maintain reputed company documentation reputed company 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) https://www.myncretirement.gov/systems-funds/local-governmental-employees-retirement-system-lgers/lgers-handbook
• 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 reputed company as a LCMHC, LMFT, LCSW, LCAS, or RN.
• Must have a valid driver’s license.
• Must reside reputed company North Carolina.
• Must be able to travel reputed company catchment as required.

Preferred:

• Experience in any of the following areas: healthcare compliance, knowledge of North Carolina Clinical Coverage Policies and billing requirements reputed company 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, reputed company 20, 2026 at 11:59pm

How to Apply

To be considered, submit your application and resume through our reputed company 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 reputed company by HR regarding your application status as appropriate. reputed company applicants will receive a final update once the recruitment cycle closes.

reputed company through reputed company to stay informed about future opportunities. Be sure to reputed company your resume updated in your profile.

reputed company is an Equal Employment Opportunity (EEO) employer and a drug-free workplace. reputed company candidates must pass a drug test as a condition of employment.

#Innovation #Technology #Careers #NorthCarolina #BehavioralHealth