Regular Programs Eligibility 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 1.4 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.
• Responsible for reviewing individual applicant applications and enrollee income, resources, and other technical elements
• Register applications as needed
• Make changes to member eligibility, establish eligibility
• Process reports to maintain accurate member caseloads
• Trouble shoot and respond to inquiries regarding member eligibility.
• Demonstrate strong customer service skills, interpretation of public policy, and problem solving
• Use proprietary computer-based systems to perform work duties
• Respond to emails, telephone calls, and other correspondence in a timely fashion
• Work in a systemic manner in partnership with vendor staff, internal customers, and external stakeholders to provide services and support to a shared client base. This will require verbal and/or electronic communications with the vendor, internal customers and outside organizations and stakeholders to obtain or share information regarding applicant/enrollee circumstances regarding eligibility and to solve eligibility related issues
• Be adept at dealing with ambiguity
• Manage time and have the ability prioritize tasks.
• Request guidance and/or training in areas of uncertainty or knowledge deficiency and participate in required training
• Strive to improve professional skills and knowledge through continuous learning to better support peers and customers.
• Exercise professional judgment to know when to escalate a concern or issue
• Remain up to date on new policies and procedures as they are implemented in order to ensure accurate eligibility determination.
• Ensure accurate and clear communications
• Explain eligibility for benefits and services
• Interpret policy and procedure in relation to the enrollee’s circumstances to ensure the member or applicant’s understanding
• Communicate the enrollee/applicant’s responsibilities to the enrollee/applicant in a way that is easily understood and ensure the enrollee/applicant’s understanding.
• Mentor new and less experienced employees/staff/co-workers to ensure understanding of information/processes, as required.
• Conducts or leads in training as required to ensure continual learning and current knowledge related to the managed care field.
The minimum qualifications are listed on the state of Tennessee’s Careers page link: https://www.tn.gov/careers/apply-here.html
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: June 4, 2021
- Type: Full-Time
- Job Function: Administrative
- Service Area: Government