WAIVER PROGRAMS ELIGIBILITY SPECIALIST

Division of TennCare

Member Services, Compliance & Policy Group (CPG)

Nashville, TN

Minimum Monthly Salary $3,534/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.

Closing Date: 12/07/2022

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 1.6 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).

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.

Key Responsibilities:

The Division of TennCare is seeking a Waiver Programs Eligibility Specialist in the Eligibility Operations Group within Member Services. This position will report directly to an Eligibility Operations Group Manager. In general, TennCare Program Coordinators on this team will work in TEDS processing applications to determine eligibility for Institutional Medicaid. The TennCare Program Coordinator will work with customers, families, facilities, and Authorized Representatives to relay clear information and expectations of the information needed for an accurate eligibility determination. Additionally, the TennCare Program Coordinator will document actions in TEDS (& other systems) when necessary.

• Review all received documents and make an eligibility determination in accordance with all rules, regulations, polices and guidelines.
• Process Medicaid applications timely according to the established policies and regulations.
• Provide support and guidance to assigned staff on matters relating to Medicaid rules, regulations, policies and procedures and organizational databases.
• Evaluate production to ensure accuracy and that production standards are met.
• Provide and participate in training, resources, and tools to increase performance and professional development of staff
• Provide excellent customer service to both internal and external stakeholders

Minimum Qualifications:

Education and Experience:

Graduation from an accredited college or university with a bachelor's degree in business administration, management, public health or health policy

OR
Graduation from an accredited college or university with an associate's degree in business administration, management, public health or health policy and two (2) years of qualifying professional experience in 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 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 in business administration, management, public health or health policy and one of the following:

• Four (4) years of experience within TennCare
• Four (4) years of experience within a Medicaid, managed care or healthcare organization.

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.

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.