Appeals Resolution and Preparation Specialist
(TennCare Program Coordinator)
TennCare is Tennessee's managed care Medicaid program that provides health insurance coverage to certain groups of low-income individuals such as pregnant women, children, caretaker relatives of young children, older adults, and adults with physical disabilities. TennCare provides coverage for approximately 1.3 million Tennesseans and operates with an annual budget of approximately $12 billion. It is run by the Division of TennCare with oversight and some funding from the Centers for Medicare and Medicaid Services (CMS).
WHY WORK AT TENNCARE?
TennCare’s mission is to improve the lives of Tennesseans by providing high-quality cost-effective care. To fulfill that purpose, we equip each employee for active participation and empower teams to communicate and work collaboratively to improve organizational processes in order to make a difference in the lives our members. Because of the positive impact TennCare has on the lives of the most vulnerable Tennesseans, TennCare employees report that their work provides them with a sense of meaning, purpose, and accomplishment. TennCare leadership understands that employees are our most valuable resource and ensures professional and leadership development are a priority for the agency.
JOB AND DEPARTMENTAL OVERVIEW
The Resolution and Preparation Specialist will try to resolve appeals prior to hearing by taking appropriate action when applicable and testify on behalf of the Division of TennCare, if the appeal reaches an administrative hearing. The Resolution and Preparation Specialist will testify in accordance with established law, rules, regulations, polices and guidelines. Additionally, the Resolution and Preparation Specialist will document actions in TEAMS (& other systems) when necessary. The Resolution and Preparation Specialist will process Medicaid applications timely according to the established law, rules, regulations, polices and guidelines, documenting TEAMS (& other systems) when necessary.
• Research/ review eligibility documents to determine if TennCare policies have been upheld.
• Process all case types to reach resolution as needed.
• Prepare information packets to provide evidence to support the state’s actions related to TennCare Medicaid programs.
• Offer testimony as the state’s witness during hearings.
• Complete special projects as assigned.
• Mentor new Program Coordinators.
· Ability to foster and maintain cohesive working relationships
· Ability to adapt to changing priorities and deadlines
· Ability to exercise sound judgment
· Strong organizational skills necessary, including the ability to prioritize, multi-task and manage workload to meet specific timeframes and deadlines
· Excellent writing and communication skills required
· Bachelor’s Degree
Job Location: Nashville, Tennessee
How to Apply: Qualified candidates should send their resumes along with a cover letter to Kierra.Claiborne@tn.gov by July 17, 2019.
Position Status: Executive Service
Pursuant to the State of Tennessee’s Workplace Discrimination and Harassment policy, the State is firmly committed to the principle of fair and equal employment opportunities for its citizens and strives to protect the rights and opportunities of all people to seek, obtain, and hold employment without being subjected to illegal discrimination and harassment in the workplace. It is the State’s policy to provide an environment free of discrimination and harassment of an individual because of that person’s race, color, national origin, age (40 and over), sex, pregnancy, religion, creed, disability, veteran’s status or any other category protected by state and/or federal civil rights laws.