TennCare Program Coordinator

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

How you make a difference in this role:

Operationally, the TennCare Appeals Processing Unit (APU) works closely with several other TennCare divisions to help process TennCare member appeals for all eligible TennCare members to ensure they receive their medically necessary care.  Externally, APU works with TennCare’s managed care organizations and other state agencies to ensure the provision of covered medical, dental, behavioral health, and pharmacy services for TennCare Members. This position will be a key member on the APU team, reporting to the TennCare Valid Factual Dispute/Reconsideration Program Manager II.

Key Responsibilities:

• Administer reporting functionality and program evaluation for the TennCare Appeals Processing Call Center Quality Control Unit:
• Maintain updated knowledge of the Medical Appeals Tracking System (MATS) which is the appeals processing database.
• Perform quality analyses and reporting on member calls that have been recorded by the TennCare Member Medical Appeals Call Center.
• Use computer software (i.e., Excel, Word, or other specialized software related to area of study) to analyze data derived from both recorded calls and MATS.
• Compare results of member call analyses over time to show trends in data.
• Maintains spreadsheet of all calls audited for quality assurance and utilizes case log to monitor daily productivity and to allow for the sharing of key insights related to the TennCare Medical Appeals Call Center to Medical Office and APU leadership, program staff, and external stakeholders at an appropriate level of audience understanding:
• Track statistical data derived from MATS and TennCare Member Medical Appeals Call Center to determine appropriate policy recommendations and corrective action plans for the call center.
• Finalize formatted documents for electronic and/or other means of distributions to unit staff and management as requested.
• Present relevant reporting information, both formally and informally, to small and large groups.
• Create presentation-ready deliverables for internal and external stakeholders.
• Manage special projects assigned by the APU Director and other members of management in the Chief Medical Office.
• Demonstrates attention to detail in researching appeal cases/member calls and documenting notes for proper call review to ensure accurately and timely appeal processing :
• Provide quality assurance expertise to review and summarize complex reports for the TennCare Appeals Processing Unit team and others upon request.
• Attends and actively participates in all unit meetings and problem-solving discussions for workflow improvements.
• Participate in ongoing MATS development and design sessions and help ensure that required updates are included in the MATS system.
• Works closely with Chief Medical Office leaders and TennCare Member Medical Appeals Call Center to achieve the required appeals processing efficiency and compliance with federal and state requirements.

Qualifications

• Bachelor’s Degree obtained from an accredited college, or university
• -OR-
• 4 years relevant experience in a healthcare setting or a combination of the two
• Strong computer skills including mastery of Microsoft Office (Excel, Access, Word, and PowerPoint)
• Ability to foster and maintain cohesive working relationships
• Sound judgment with the ability to adapt to changing priorities and deadlines
• Clear and concise oral and written communication skills
• Strong organizational skills, including the ability to prioritize, multi-task, and manage workload to meet specific timeframes and deadlines
• Preferred: Experience in healthcare field and/or with quality measurement
• Preferred: Strong grasp of Medicaid policy

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: May 7, 2021
• Type: Full-Time
• Job Function: Administrative
• Service Area: Government