APPLICATION MONITORING SPECIALIST - 54267

APPLICATION MONITORING SPECIALIST

Division of TennCare

Nashville, TN

Minimum Monthly Salary: $3,958/month

Closing Date: 01/29/2024

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.

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 Application Monitoring Specialist to work in the Vendor Operations Group within Member Services and will report directly to a Vendor Operations Group Manager. The Application Monitoring Specialist will be responsible for providing support and guidance on matters relating to Medicaid rules, regulations and policies. The Application Monitoring Specialist will work collaboratively with management to identify workflow issues and accomplishments. This position will utilize organizational skills, effective communication and exercise sound judgement to execute actions necessary to fulfill objectives that support TennCare's mission and vision.

Key Responsibilities:

• Conduct audits of phone calls, tasks, chats, and documents in support of Contract service level agreements
• Analyze audit data to establish trends and determine root causes
• Prepare reports to document trends and propose corrective actions
• Complete tasks and reviews within appropriate databases
• Resolve member's issues by taking the appropriate action when applicable
• Maintain knowledge of changing policies and processes within the organization
• Participate in other special projects as business needs dictate

Minimum Qualifications:

Education equivalent to graduation from an accredited college, university, or professional school with one of the following:

• Bachelor's Degree or 4 years relevant experience or a combination of the two
• 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:

• 1 year of eligibility experience working in eligibility determination
• Bilingual (English/Spanish); ability to read, write, and speak Spanish fluently

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.