TENNCARE PROGRAM COORDINATOR - EXECUTIVE
State of Tennessee
Position Description / Responsibilities
JOB AND DEPARTMENTAL OVERVIEW
This position will work in the Compliance and Policy Group of Member Services and will report directly to the Assistant Quality Control Director. This position is responsible for performing accurate quality control functions within the Tennessee Eligibility Determination System (TEDS), implementing federally mandated audit activities, and undertaking proactive reviews of Member Services operations. This position requires the ability to provide accurate and concise responses to quality control inquires relating to all aspects of Medicaid eligibility and Member Services operations.
- Review and analyze caseworkers’ actions taken in TEDS to determine accuracy and compliance.
- Review and analyze business processes, system functionality, and eligibility documentation to ensure compliance with regulatory authority and internal requirements.
- Remain current on all Medicaid eligibility policy updates and TEDS design materials.
- Implement corrective action plans resulting from audit/quality control findings.
- Field and respond to all eligibility-related questions from internal and external stakeholders.
- Bachelor’s Degree
- 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
- Strong grasp of Medicaid policy
- Experience in quality control such as evaluating the quality of services, identifying problems and needs, and recommending corrective action and improvements to ensure optimum service delivery will be considered a plus.
Apply Here: TN.gov/Careers