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.
1. 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
2. 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
• 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
• Communication with member(s) should be clear, concise and ensure that member(s) are aware of all verifications needed to determine eligibility
• Respond to all required communications in a timely manner
• Responsible for reading and applying all communications that is received and escalating any question/concerns to management
• Mentor new and less experienced employees/staff/co-workers to ensure understanding of information/processes, as required
• Willing to conduct, lead, and participate in trainings to assist in continued development of self and peers
• Strive to improve professional skills and knowledge through continuous learning
For preferred jobs on CNM (Qualifications): To see the minimum qualifications for this job, please go to the State of Tennessee Careers site listed below.
For more information about the great benefits available to State of Tennessee employees; click here: https://www.tn.gov/hr/employees1/benefits.html
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!
- Date Posted: January 6, 2021
- Type: Full-Time
- Job Function: Legal
- Service Area: Government