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TennCare

Regular Programs Eligibility 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 Responsibilities

Determining Eligibility

    • Responsible for reviewing and processing new applications to determine Medicaid/MSP eligibility based on
  • Non-Financial and Financial criteria
  • Monitor individual tasks in TEDS and Employee Performance dashboards
  • Troubleshoot and respond to inquiries regarding member eligibility
  • Demonstrate strong critical thinking and problem-solving skills
  • Utilize TennCare Policy to determine Medicaid/MSP eligibility accurately
  • Use proprietary computer-based systems to perform work duties
  • Monitor queues to ensure timely task/case processing

Customer Service/Time Management

    • Communicate with vendor staff, internal customers, and external stakeholders to provide services and support to
  • resolve eligibility related issues
  • Be proficient at dealing with several interpretations of an issue and finding a workable solution
  • Manage time and attendance
  • Prioritize tasks based on the needs of the agency
  • Correct cases that have identified errors and provide a summary to upper management, as necessary, for quality
  • assurance
  • Request guidance and/or training in areas of uncertainty or knowledge deficiency and participate in required trainings
  • Escalate questions, concerns, and issues to management

Communication

  • Remain up to date on new policies and procedures as they are implemented in order to ensure accurate eligibility determination
  • Attend Staff meetings with peers and one on one meetings with supervisor
  • Ensure accurate and clear communications through all mediums
  • Explain eligibility for benefits and services to members, when necessary

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

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 

Details

  • Date Posted: July 16, 2021
  • Type: Full-Time
  • Job Function: Administrative
  • Service Area: Government