Appeals Litigations Preparation Specialist
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 1.5 million Tennesseans and operates with an annual budget of approximately $12.9 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 Preparation Specialist for the Appeals Operations Group within Member Services. The Appeals Litigation Preparation Specialist will resolve appeals before hearing by taking appropriate action when applicable and testify on behalf of the Division of TennCare, if the appeal reaches an administrative hearing. The Appeals Litigation Preparation Specialist will testify in accordance with established law, rules, regulations, policies, and guidelines. The Appeals Litigation Preparation Specialist will document actions in TEDS (& other systems) when necessary. Additionally, the Appeals Litigation Preparation 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 Preparation Specialist will also work collaboratively with management to identify workflow issues and accomplishments.
- Ability to maintain a high-volume caseload and adhere to the timeliness standard of appeals while conducting the
- due process review.
- Assist in achieving a high-performing and positive work environment that will promote the TennCare Mission.
- Prepares information packets to provide evidence to support the state’s actions related to TennCare Medicaid
- programs and testifies as the state’s witness during hearings.
- Daily receives and reviews appeals for potential resolution within policy guidelines. If resolution cannot be found,
- move 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.
- Ability to navigate TEDS
- Education equivalent to graduation from an accredited college, university, or professional school with one of the
- Bachelor’s Degree or 4 years relevant experience or a combination of the two
- 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
- Advanced writing and communication skills
To see all the great benefits available to State of Tennessee employees, go to the TN.gov Benefits page: https://www.tn.gov/hr/employees1/benefits.html
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
- Date Posted: July 16, 2021
- Type: Full-Time
- Job Function: Administrative
- Service Area: Government