What are the responsibilities and job description for the OPS ENROLL SPECIALIST position at Smart IMS?
**This is a onsite position - only candidates in middle Tennessee and able to commute to Nashville, TN regularly will be considered.**
The standard work week is 37.5 hrs./wk.
Enrollment functions: Reviews enrollment details and effective dates to ensure accuracy prior
to enrolling member. Works with team members to determine appropriate program enrollment.
Enters, deletes, and revises enrollment related actions in interChange. Assists in the
redetermination process and submits lists of all members to be renewed to appropriate
external partners.
Disenrollment functions: Reviews and processes all requested and approved disenrollments,
whether voluntary or involuntary, for TennCare LTSS members in an accurate and timely
manner. Ensure effective dates are accurate and research discrepancies related to effective
dates, preventing eligibility issues for members, providers, and MCOs. Communicate
disenrollment's for the Katie Beckett program to program leadership.
Transcribe approved PASRR determinations from the TMED system into the PERLSS system to allow for additional enrollment and eligibility actions to be taken on completed records.
The LTSS Operations team is requesting a contractor to assist with Enrollment Specialist level work related to enrolling and disenrolling TennCare members. Due to the implementation of a new eligibility system, PERLSS, the enrollment team is in need of additional assistance to manage the workload. PERLSS implementation requirements have increased the workload of existing team members and additional support is needed to maintain daily functions of the enrollment team to ensure enrollments and disenrollment's are handled timely and accurately.
The contractor role will allow the enrollment team members to manage PERLSS
related work, including monitoring and reporting defects, process improvements, and required work related to additional PERLSS implementation phases.
Additionally, with the Public Health Emergency ending, redeterminations for Medicaid programs will be restarting at the end of March. This will result in an increase in work as this process has been on hold for three (3) years and the enrollment team will be monitoring and following up on lists shared with MCOs, Nursing Facilities, DIDD, and other state partners to assist members with going through the renewal process. The contractor will provide needed assistance for the full redetermination process, ensuring no members lose eligibility that are attempting to go through this process.
Action Plan Timeline
The contractor will be needed for 12 months.
Month 1: Training on new role, including shadowing and completion of new hire onboarding process.
Month 2: The contractor will begin working independently, with hands on support and monitoring of supervisor, on enrollment related tasks. These include enrollment and disenrollment functions, transcribing approved PASRR determinations into the TMED system, and assisting with redetermination processes. Weekly check ins to occur with
supervisor to monitor productivity and answer questions.
Months 4-10: The contractor will be fully independent in role and providing support with enrollment tasks. This will also include providing required reports, as needed, to supervisor. In months 9 and 10, supervisor and contractor will begin discussing transition plan for tasks, to include a review of eligibility system implementation related tasks that are close to
completion or have already been completed.
Months 11-12: The contractor will work with the enrollment team on transitioning responsibilities to team members and finalizing outstanding work tasks. The contractor and supervisor will create a transition plan to minimize transition related gaps, ensuring compliance to Rules and required timeframes.
Minimum qualifications
Graduation from an accredited college or university with a bachelor's degree or graduation from an accredited college or
university with an associate's degree and two years of qualifying professional experience
Excellent verbal and written communications skills
Proven technical skills (e.g. Microsoft Word, Excel, Outlook, PowerPoint, SharePoint, etc.)
Excellent time management skills and ability to multi-task and prioritize work in order to meet specific timeframes and
deadlines with minimal supervision
Keen attention to detail and adherence to deadlines
Organization
Self-motivated and able to thrive in a fast-paced and results-driven environment
Critical thinking and problem-solving skills
Qualifications
Type
Category
Qualification
Description
Competency
Required
Education
Others
Bachelors Degree
Graduation from an accredited college or university with a bachelor's degree or graduation from an accredited college or university with an associate's degree and two years of qualifying professional experience
Proficient (4-6 Years)
No
Skills
Others
Critical Thinking
Critical thinking and problem-solving skills
Proficient (4-6 Years)
No
Skills
Others
Excellent verbal and written communications skills
Proficient (4-6 Years)
No
Skills
Others
Microsoft Office
Proven technical skills (e.g. Microsoft Word, Excel, Outlook, PowerPoint, SharePoint, etc.)
Proficient (4-6 Years)
No
The standard work week is 37.5 hrs./wk.
Enrollment functions: Reviews enrollment details and effective dates to ensure accuracy prior
to enrolling member. Works with team members to determine appropriate program enrollment.
Enters, deletes, and revises enrollment related actions in interChange. Assists in the
redetermination process and submits lists of all members to be renewed to appropriate
external partners.
Disenrollment functions: Reviews and processes all requested and approved disenrollments,
whether voluntary or involuntary, for TennCare LTSS members in an accurate and timely
manner. Ensure effective dates are accurate and research discrepancies related to effective
dates, preventing eligibility issues for members, providers, and MCOs. Communicate
disenrollment's for the Katie Beckett program to program leadership.
Transcribe approved PASRR determinations from the TMED system into the PERLSS system to allow for additional enrollment and eligibility actions to be taken on completed records.
The LTSS Operations team is requesting a contractor to assist with Enrollment Specialist level work related to enrolling and disenrolling TennCare members. Due to the implementation of a new eligibility system, PERLSS, the enrollment team is in need of additional assistance to manage the workload. PERLSS implementation requirements have increased the workload of existing team members and additional support is needed to maintain daily functions of the enrollment team to ensure enrollments and disenrollment's are handled timely and accurately.
The contractor role will allow the enrollment team members to manage PERLSS
related work, including monitoring and reporting defects, process improvements, and required work related to additional PERLSS implementation phases.
Additionally, with the Public Health Emergency ending, redeterminations for Medicaid programs will be restarting at the end of March. This will result in an increase in work as this process has been on hold for three (3) years and the enrollment team will be monitoring and following up on lists shared with MCOs, Nursing Facilities, DIDD, and other state partners to assist members with going through the renewal process. The contractor will provide needed assistance for the full redetermination process, ensuring no members lose eligibility that are attempting to go through this process.
Action Plan Timeline
The contractor will be needed for 12 months.
Month 1: Training on new role, including shadowing and completion of new hire onboarding process.
Month 2: The contractor will begin working independently, with hands on support and monitoring of supervisor, on enrollment related tasks. These include enrollment and disenrollment functions, transcribing approved PASRR determinations into the TMED system, and assisting with redetermination processes. Weekly check ins to occur with
supervisor to monitor productivity and answer questions.
Months 4-10: The contractor will be fully independent in role and providing support with enrollment tasks. This will also include providing required reports, as needed, to supervisor. In months 9 and 10, supervisor and contractor will begin discussing transition plan for tasks, to include a review of eligibility system implementation related tasks that are close to
completion or have already been completed.
Months 11-12: The contractor will work with the enrollment team on transitioning responsibilities to team members and finalizing outstanding work tasks. The contractor and supervisor will create a transition plan to minimize transition related gaps, ensuring compliance to Rules and required timeframes.
Minimum qualifications
Graduation from an accredited college or university with a bachelor's degree or graduation from an accredited college or
university with an associate's degree and two years of qualifying professional experience
Excellent verbal and written communications skills
Proven technical skills (e.g. Microsoft Word, Excel, Outlook, PowerPoint, SharePoint, etc.)
Excellent time management skills and ability to multi-task and prioritize work in order to meet specific timeframes and
deadlines with minimal supervision
Keen attention to detail and adherence to deadlines
Organization
Self-motivated and able to thrive in a fast-paced and results-driven environment
Critical thinking and problem-solving skills
Qualifications
Type
Category
Qualification
Description
Competency
Required
Education
Others
Bachelors Degree
Graduation from an accredited college or university with a bachelor's degree or graduation from an accredited college or university with an associate's degree and two years of qualifying professional experience
Proficient (4-6 Years)
No
Skills
Others
Critical Thinking
Critical thinking and problem-solving skills
Proficient (4-6 Years)
No
Skills
Others
Excellent verbal and written communications skills
Proficient (4-6 Years)
No
Skills
Others
Microsoft Office
Proven technical skills (e.g. Microsoft Word, Excel, Outlook, PowerPoint, SharePoint, etc.)
Proficient (4-6 Years)
No
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