Appeals Order Implementation Specialist
State of Tennessee
HR, Office & Administrative Support
Position Description / Responsibilities
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 Legal Assistant will work in the Appeals Operation Group’s Order Implementation Unit with Tenncare Member Services. This position is responsible for implementing or executing legal court orders that have been rendered as a result of the Division of Tenncare appeal hearing process. The Legal Assistant’s duties consist of interpreting Medicaid policy/procedures, determining eligibility for new or existing Tenncare Medicaid/Medicare coverage programs, ensuring Medicaid category accuracy and implementing court orders for appeal resolution.
Demonstrate ability to process and implement all rendered Appeal Orders accurately
Maintain identified case review accuracy while adhering to specified timeliness factors
Review and interpret court language in order to correctly implement appeal orders
Navigate through various Tenncare systems and software programs to carryout day-to-day tasks
Remain current on Tenncare Medicaid/Medicare eligibility policy and procedures
Communicate and execute Medicaid/Medicare eligibility and Order Implementation matters from internal and external stakeholders.
Education equivalent to graduation from an accredited college, university, or professional school with one of the following:
OR Bachelor’s Degree;
OR Paralegal Certificate;
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
Experience in interpreting Medicaid Policy or determining eligibility for Tenncare Medicaid/Medicare state assistance programs will be a plus but not required
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.
JOB LOCATION: Nashville, Tennessee
HOW TO APPLY: Qualified candidates should send their resumes along with a cover letter to MemberServices.Jobs@tn.gov by December 11, 2019. Applicants must include “Appeals Order Implementation Specialist – Legal Assistant” in the subject line of e-mail.