Appeals Registration 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 Registration Specialist in the Appeals Operation Group within Member Services. The Appeals Registration Specialist will perform duties in support of the clerk’s office intake process and processes associated with the proper classification and determination of all appellant documentation. The Appeals Registration Specialist is required to be thoroughly familiar with Medicaid rules, regulations and policies to ensure that eligibility determinations are accurately made, and that resolution of appeals are appropriate. This position will also generate notices and letters, serve in the Clerk’s Office call center, schedule appeal related hearings and work closely with the print and mail departments.

Job Responsibilities

• Perform administrative functions such as scheduling appeals for hearings, routing continuance requests as necessary and preparing technical records for hearings
• Create electronic records of appeal requests
• Arrange for translation services when appropriate
• Maintain attorneys’ calendars, hearing calendars and the litigation timetables for attorneys
• Research, review and implement all court orders rendered from an appeal hearing
• Remain current on Tenncare Medicaid/Medicare eligibility policy and procedures
• May determine eligibility and/or extend Medicaid coverage to match order request

Qualifications

• A minimum of an Associate degree or 3 years of full-time professional experience, preferably in public health, health policy, or social services field
• Ability to adapt to changing priorities and deadlines
• Ability to exercise sound judgment
• Ability to foster and maintain cohesive working relationships
• Basic organizational skills, including the ability to prioritize, multi-task and manage workload to meet specific timeframes and deadlines
• Developed writing and communication skills

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: March 31, 2021
• Type: Full-Time
• Job Function: Administrative
• Service Area: Government