Appeals Redetermination 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 a TennCare Program Coordinator for the Appeals Operations Group. The TennCare Program Coordinator will be responsible for providing support and guidance on matters relating to Medicaid rules, regulations and policies. The TennCare Program Coordinator 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 TennCare Program Coordinator will also work collaboratively with the Managed Care Program Manager 2 to identify work flow issues and accomplishments.

Job Responsibilities

• Daily receives and reviews appeals for potential resolution within policy guidelines. If resolution cannot be found, moves the case forward in the appeal continuum timely for hearing.
• Demonstrates attention to detail in researching appeal cases and documenting notes for proper case processing.
• Maintain case log to ensure all appeals are worked in the order received and follow-up is timely in waiting for responses from manager or other department. Utilizes case log to report daily productivity to manager.
• Makes phone calls as needed to verify information with appellant regarding appeal.
• Attends and actively participates in all unit meetings and problem-solving discussions for workflow improvements.

Qualifications

MINIMUM QUALIFICATIONS

• Ability to foster and maintain cohesive working relationships
• Ability to adapt to changing priorities and deadlines
• Ability to exercise sound judgment
• Strong organizational skills, including the ability to prioritize, multi-task and manage workload to meet specific timeframes and deadlines
• Excellent writing and communication skills

DESIRABLE QUALIFICATIONS

• Education equivalent to graduation from an accredited college, university, or professional school with one of the following:
• Bachelor’s degree in Paralegal or Legal Assistant studies;
  o OR Paralegal certificate;
  o OR one year (28 semester hours) of graduate level law school

Additional Information

Benefits

How to Apply

Please go to https://www.tn.gov/careers/apply-here.html. Search by “job title” or by “TennCare” to see all of our current job opportunities. Apply today!

Details

• Date Posted: January 6, 2021
• Type: Full-Time
• Job Function: Legal
• Service Area: Government