Trillium Health Resources

• Ensure claims payment reports are generated and analyzed to determine problems. • Ensure analysis, research, and corrections are completed in a timely manner to ensure provider payment. • Assist in developing and maintaining claim processing procedures and ensuring these procedures are understood and followed by claims staff. • Interact with the provider community to address billing issues. • Train and mentor staff on claims processing duties to enhance team performance.

• Lead and manage provider network staff, including performance, coaching, and accountability • Direct execution of network development and management activities to support provider performance and value-based care • Monitor provider performance, capacity, and compliance to identify gaps and support network optimization • Lead resolution of provider performance issues, access barriers, and network deficiencies • Oversee provider data accuracy and performance analytics to support reporting, decision making, and value-based care initiatives

• Assist with long-range planning for enhancement and implementation of future business systems. • Discover and contribute to the development, implementation, and maintenance of business systems functional architecture, detail systems design, configuration, or program specifications. • Facilitate daily standups (or the daily scrum) as needed. • Participate in sprint reviews and capture feedback. • Provide administrative support for scrum board. • Ensure cards are up to date and scrum tools are working well. • Collaborate with team members and other internal stakeholders. • Perform regular analysis of burndown charts and other portfolio planning tools.

• Submit operational reports and contractual deliverables via appropriate systems in a timely manner with extensive attention to detail • Download reports requiring corrections, share with IT and Business teams for updates, and resubmit within required timeframes • Download updated technical documents to maintain up-to-date documentation internally • Analyze information support and participation needs to deliver outcomes that match business needs and IT capacity • Assist IT Business Integrations Director with various projects as assigned

• Responsible for maintenance of the TCM provider network through effective contract monitoring, relationship development, and provider support. • Collaborates with Advance Medical Home Plus (AMH+) and Care Management Agency (CMA) providers to ensure that Trillium meets all required benchmarks. • Responsible for provider oversight and compliance, including meeting facilitation, technical assistance, and monitoring. • Supervises a team of TCM Coordinators and develops processes and protocols to ensure uniformity in supporting, monitoring, and ensuring contract compliance of all certified and contracted TCM Providers.

• The RCT (RB-BHT) Care Manager is responsible for providing complex care coordination and monitoring to members having a primary Intellectual or Developmental Disability, which may include a secondary mental health or substance abuse, and/or complex medical/physical health need. • The RCT (RB-BHT) Care Manager assists with integrated care management through multi-disciplinary collaborations and referrals, including but not limited to: assistance with the TCM opt in/opt out process, completion of care needs screenings, 90 day transition plans, completion/updates of CMCAs and care plan development, and service coordination as needed/deemed appropriate. • This position has a primary focus on members that have been diagnosed with Autism Spectrum Disorder, particularly children (18mos – 15yo). • Utilize person centered planning methods/strategies to gather information, to get to know the members supported and to adequately address specific needs of the individual. • Provide education and support to members in learning about and exercising rights and responsibilities. • Scheduling and completion of NC Medicaid 1915i Assessment. • Complete Discovery activities (information gathering and assessment) as a component of the planning process. • Ensure that members/legally responsible persons are informed of services available (all types of Medicaid and state-funded services), service options available (e.g. Individual/Family Direction for Innovations participants), processes (e.g. requirements for specific service), Natural and community services, and so forth.

• Lead and manage provider relations staff, including performance, coaching, and accountability • Oversee provider communication, inquiry resolution, and engagement activities across the network • Monitor provider satisfaction, service levels, and responsiveness to identify trends and improvement opportunities • Direct resolution of complex provider issues and escalations impacting provider experience • Analyze provider feedback and inquiry trends to improve communication strategies and service delivery • Partner with internal teams to resolve cross-functional issues affecting providers

• Monitor and ensure business systems remain operational. • Act as liaison between multiple departments for business system operations, upgrades, and maintenance. • Oversee and coordinate User Acceptance Testing (UAT) for any upgrades to the business systems pursuant to the Agile flow. • Respond to tickets from the KACE System and record the issues and solutions in the KACE System. • Contribute to the development, implementation, and maintenance of business systems functional architecture, detail systems design, configuration, or program specifications to deliver IT system outcomes that meet user and organizational needs.

• Analyze and maintain EDI data flows • Ensure data accuracy and integrity EDI transactions • Collaborate with IT teams to integrate EDI systems with internal applications • Troubleshoot and resolve EDI integration issues • Create and maintain documentation for EDI processes and standards

• Develop and lead Community Oversight/Regional Advisory Boards and support the Consumer and Family Advisory Committee in understanding the performance of the LME/MCO, ensuring that community needs and concerns are represented and addressed appropriately. • Assist in developing an annual plan of work aligned with the LME/MCO goals. • Oversee Community Liaison budgets; ensuring reports regarding budgets are prepared for review. • Establish and maintain community relationships through Community Advisory Councils and participation on external councils, boards and committees. • Provide direction in the development and streamlining of procedures and processes.