Appeals Litigation Administration Specialist

TennCare

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Job Summary

TENNCARE OVERVIEW

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 1.4 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 Division of TennCare is seeking an Appeals Litigation Administration Specialist for Appeals Operations Group within Member Services. The Appeals Litigation Administration Specialist will be responsible for providing support and guidance on matters relating to Medicaid rules, regulations and policies. Additionally, the Appeals Litigation Administration Specialist will ensure that due process standards are met in Medicaid appeals by the accurate and timely processing of appeals and all appeals related documents. Finally, the Appeals Litigation Administration Specialist will also work collaboratively with management to identify workflow issues and accomplishments.

Job Responsibilities

•  Ability to maintain a high-volume caseload and adhering to the timeliness standard of appeals while conducting the due process review.
•  Assist in the achievement of a high performing and positive work environment that will promote the TennCare Mission.
• Receives and reviews appeals for potential resolution within policy guidelines daily. If resolution cannot be found, the coordinator moves the case forward in the appeal continuum for hearing.
• Demonstrates attention to detail in researching appeal cases and documenting notes for proper case processing.
• Attends and actively participates in all unit meetings and problem-solving discussions for workflow improvements.
• Complete special projects as assigned.
• Makes phone calls as needed to verify information with appellant regarding appeal.
• Ability to navigate TEDS

Qualifications

The minimum qualifications are listed on the state of Tennessee’s Careers page link: https://www.tn.gov/careers/apply-here.html

Additional Information

Benefits

How to Apply

To apply for this job or see other opportunities at TennCare, visit the state of Tennessee’s Careers page today: https://www.tn.gov/careers/apply-here.html 

Details

• Date Posted: June 25, 2021
• Type: Full-Time
• Job Function: Administrative
• Service Area: Community Development