APPEALS ORDER IMPLEMENTATION SPECIALIST - 64264

Executive Service

Appeals Order Implementation Specialist

Division of TennCare

Member Services - Appeals Operations Group (AOG)

Nashville, TN

Salary : Minimum Monthly Salary $4,017 / 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.

Closing Date : 01 / 20 / 2025

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.

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 an Appeals Order Implementation Specialist in the Appeals Operation Group within Member Services. The Appeals Order Implementation Specialist 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 Appeals Order Implementation Specialists' 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. This position is required to be thoroughly familiar with Medicaid rules, regulations and policies to ensure that communication and appeal orders are correctly implemented.

Key Responsibilities :

• 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.

Minimum Qualifications :

Education and Experience : Education equivalent to graduation from an accredited college, university, or professional school with one of the following : (1) an Associate's Degree in Paralegal or Legal Assistant studies; (2) a Bachelor's Degree in Paralegal or Legal Assistant studies; (3) a Paralegal Certificate; or (4) one year (28 semester hours) of graduate level law school.

Education equivalent to graduation from a standard high school and two years of full-time experience in researching legal issues and documenting findings to assist in building case files, settling legal disputes, and / or providing legal counsel to clients.

an equivalent combination of education and work experience may be considered

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.

Salary : $4,017