Waiver 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 AND DEPARTMENTAL OVERVIEW

The Division of TennCare is seeking a Waiver Programs Eligibility Specialist in the Eligibility Operations Group within Member Services. This position will report directly to an Eligibility Operations Group Manager. In general, TennCare Program Coordinators on this team will work in TEDS processing applications to determine eligibility for Institutional Medicaid. The TennCare Program Coordinator will work with customers, families, facilities, and Authorized Representatives to relay clear information and expectations of the information needed for an accurate eligibility determination. Additionally, the TennCare Program Coordinator will document actions in TEDS (& other systems) when necessary.

Job Responsibilities

 • Review all received documents and make an eligibility determination in accordance with all rules, regulations, polices and guidelines.

• Process Medicaid applications timely according to the established policies and regulations.

• Provide support and guidance to assigned staff on matters relating to Medicaid rules, regulations, policies and procedures and organizational databases.

• Evaluate production to ensure accuracy and that production standards are met.

• Provide and participate in training, resources, and tools to increase performance and professional development of staff

• Provide excellent customer service to both internal and external stakeholders

Qualifications

• Education equivalent to graduation from an accredited college, university, or professional school with one of the following:

O Bachelor’s Degree or 4 years relevant experience or a combination of the two

• Ability to foster and maintain cohesive working relationships

• Ability to adapt to changing priorities and deadlines

• Ability to exercise sound judgment

• Strong organizational skills necessary, including the ability to prioritize, multi-task and manage workload to meet specific timeframes and deadlines

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