Appeals Issue Resolution Specialist

State of Tennessee

Nashville, TN

HQ, Office & Administrative Support


Position Description / Responsibilities

(TennCare Program Coordinator)

 

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 1.3 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 Appeals Issues Resolution Specialist for Appeals Operations Group within Member Services. AIR Specialist will be responsible for providing support and guidance on matters relating to Medicaid rules, regulations and policies. Additionally, the AIR Specialist will ensure that due process standards are met in Medicaid appeals by the accurate and timely processing of appeals and all appeals related documents. Finally, the AIR Specialist will also work collaboratively with the Managed Care Program Manager 2 to identify work flow issues and accomplishments.

 

RESPONSIBILITIES

 

·        Ability to maintain a high volume caseload and adhering to the timeliness standard of the AIR appeals while conducting the due process review.

·        Assist in the achievement of a high performing and positive work environment that will promote the TennCare Mission.

 


Position Requirements

QUALIFICATIONS

 

·        Bachelor’s Degree (preferred)

·        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

·        Excellent writing and communication skills required

 

Job Location:  Nashville, Tennessee

  

Position Status: Executive Service

 

Pursuant to the State of Tennessee’s Workplace Discrimination and Harassment policy, the State is firmly committed to the principle of fair and equal employment opportunities for its citizens and strives to protect the rights and opportunities of all people to seek, obtain, and hold employment without being subjected to illegal discrimination and harassment in the workplace. It is the State’s policy to provide an environment free of discrimination and harassment of an individual because of that person’s race, color, national origin, age (40 and over), sex, pregnancy, religion, creed, disability, veteran’s status or any other category protected by state and/or federal civil rights laws.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


Application Instructions

How to Apply: Qualified candidates should send their resumes along with a cover letter to Kierra.Claborne@tn.gov  by May 15, 2019

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