APPEALS ISSUE RESOLUTION SPECIALIST - 50264

State of TN
Nashville, TN Full Time
POSTED ON 9/14/2023 CLOSED ON 9/28/2023

What are the responsibilities and job description for the APPEALS ISSUE RESOLUTION SPECIALIST - 50264 position at State of TN?

Executive Service

APPEALS ISSUE RESOLUTION SPECIALIST

Division of TennCare

Nashville, TN

Minimum Monthly Salary $3,958/month

TennCare compensation is equitable and will be based on education and experience for a qualified candidate in accordance with Department of Human Resources (DOHR) policy.

The Division of TennCare is dedicated to providing our employees with a hybrid work environment. All TennCare positions have a combination of work from home and work in the office, which varies by position, department, and business need. You may review the specific expectations with our hiring team.

This position requires a background check. Therefore, you may be required to provide information about your criminal history in order to be considered for this position.

Closing Date 09/27/2023

Who we are and what we do:

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 1.7 million Tennesseans and operates with an annual budget of approximately $14 billion. It is run by the Division of TennCare with oversight and some funding from the Centers for Medicare and Medicaid Services (CMS).

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 worked 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 Overview:

The Division of TennCare is seeking Appeals Issue Resolution Specialist for Appeals Operations Group within Member Services. The Appeals Issue Resolution Specialist will be responsible for providing support and guidance on matters relating to Medicaid rules, regulations, and policies. Additionally, this role 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 Appeals Issue Resolution Specialist will also work collaboratively with management to identify workflow issues and accomplishments.

Key Responsibilities:

  • Maintain a high-volume caseload and adhere 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.
  • Receive and review appeals for potential resolution within policy guidelines daily. If resolution cannot be found, the coordinator moves the case forward in the appeal continuum for hearing.
  • Maintain case log to ensure all appeals are worked in the order received and follow up is timely is waiting for response from manager or other department. Utilize case log to report daily productivity to manager.
  • Demonstrate attention to detail in researching appeal cases and documenting notes for proper case processing.
  • Attend and actively participate in all unit meetings and problem-solving discussions for workflow improvements.

Minimum Qualifications:

Education and Experience:

  • Graduation from an accredited college or university with a bachelor's degree in a related field (preferred degree in business administration, management, public health or health policy)

OR

  • Graduation from an accredited college or university with an associate's degree in a related field (preferred degree in business administration, management, public health or health policy) and two (2) years of qualifying professional experience in a related field (preferably positions associated with the interpretation and application of policy or executing procedural provisions and/or eligibility within a health, healthcare, or health insurance setting).

Substitution of experience for education:

  • Experience equivalent to four (4) or more years of qualifying professional experience in a related field (preferably positions associated with the interpretation and application of policy or executing procedural provisions and/or eligibility within a health, healthcare, or health insurance setting).
  • 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

Desirable qualifications:

  • Graduation from an accredited college or university with a bachelor's degree, preferably in business administration, management, public health or health policy
  • Four (4) years of experience within TennCare
  • Four (4) years of experience within a Medicaid, managed care or healthcare organization.

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.

Remote, Financial Customer Care Specialist - Tennessee
First Call Resolution -
Nashville, TN
APPEALS FLEX SPECIALIST - 62074
TennCare -
Nashville, TN
Patient Account Resolution Specialist - Remote
QHR Health, LLC dba Ovation Healthcare -
Lafayette, TN

For Employer
Looking for Real-time Job Posting Salary Data?
Keep a pulse on the job market with advanced job matching technology.
If your compensation planning software is too rigid to deploy winning incentive strategies, it’s time to find an adaptable solution. Compensation Planning
Enhance your organization's compensation strategy with salary data sets that HR and team managers can use to pay your staff right. Surveys & Data Sets

Sign up to receive alerts about other jobs with skills like those required for the APPEALS ISSUE RESOLUTION SPECIALIST - 50264.

Click the checkbox next to the jobs that you are interested in.

  • Computer Troubleshooting Skill

    • Income Estimation: $82,237 - $108,966
    • Income Estimation: $79,570 - $100,091
  • Data Control Skill

    • Income Estimation: $54,523 - $80,021
    • Income Estimation: $58,238 - $80,450
This job has expired.
View Core, Job Family, and Industry Job Skills and Competency Data for more than 15,000 Job Titles Skills Library

Not the job you're looking for? Here are some other APPEALS ISSUE RESOLUTION SPECIALIST - 50264 jobs in the Nashville, TN area that may be a better fit.

Remote, Customer Care Specialist - Tennessee

First Call Resolution, Nashville, TN