WAIVER PROGRAMS ELIGIBILITY SPECIALIST - 08042026- 79579

Job Information

State of Tennessee Job Information

LOCATION OF (1) POSITION(S) TO BE FILLED: DIVISION OF TENNCARE, DAVIDSON COUNTY

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

Qualifications

Education and Experience: 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 related to administrative, customer service and/or data entry positions associated with the application of policy or executing procedural provisions and/or eligibility within a health or healthcare, casework, or an insurance setting.

Substitution of Experience for Education: Qualifying professional experience related to administrative, customer service and/or data entry positions associated with the application of policy or executing procedural provisions and/or eligibility within a health or healthcare, casework, or an insurance setting may substitute for the required education to a maximum of four years (e.g., experience equivalent to one year of full-time work in one or a combination of the above listed fields may substitute for one year of the required education).

Substitution of Experience for Education: Two years of full-time work as a Managed Care Specialist with the State of Tennessee.

Necessary Special Qualifications: A valid motor vehicle operator's license may be required.

Overview

Under general supervision, is responsible for highly technical professional TennCare program work of considerable difficulty and/or supervisory work of average difficulty; and performs related work as required. This is the highly technical professional or supervisory class in the Managed Care Specialist sub-series. An employee in this class performs highly technical TennCare program work or supervises a small to moderate sized unit of Managed Care Specialists and/or sub professional staff performing TennCare duties. This class differs from Managed Care Specialist 2 in that an incumbent of the latter performs TennCare program work of average difficulty and is not responsible for highly technical or supervisory work.

Responsibilities

Waiver Programs Eligibility Specialist

Determining Eligibility

• Responsible for reviewing individual applicant applications and enrollee income, resources and other technical elements
• 2. Register applications as needed
• 3. Make changes to member eligibility, establish eligibility
• 4. Process reports to maintain accurate member caseloads
• 5. Trouble shoot and respond to inquiries regarding member eligibility.
• 6. Demonstrate strong customer service skills, interpretation of public policy, and problem solving
• 7. Use proprietary computer-based systems to perform work duties
• 8. Respond to emails, telephone calls, and other correspondence in a timely fashion

Customer Service/Time Management

9. Work in a systemic manner in partnership with vendor staff, internal customers, and external stakeholders to provide services and support to a shared client base. This will require verbal and/or electronic communications with the vendor, internal customers and outside organizations and stakeholders to obtain or share information regarding applicant/enrollee circumstances regarding eligibility and to solve eligibility related issues

10. Be adept at dealing with ambiguity

11. Manage time and have the ability prioritize tasks.

12. Request guidance and/or training in areas of uncertainty or knowledge deficiency and participate in required training

13. Strive to improve professional skills and knowledge through continuous learning to better support peers and customers.

14. Exercise professional judgment to know when to escalate a concern or issue

Communication

15. Remain up to date on new policies and procedures as they are implemented in order to ensure accurate eligibility determination.

16. Ensure accurate and clear communications

17. Explain eligibility for benefits and services

18. Interpret policy and procedure in relation to the enrollee's circumstances to ensure the member or applicant's understanding

19. Communicate the enrollee/applicant's responsibilities to the enrollee/applicant in a way that is easily understood and ensure the enrollee/applicant's understanding.

Training

20. Mentor new and less experienced employees/staff/co-workers to ensure understanding of information/processes, as required.

21. Conducts or leads in training as required to ensure continual learning and current knowledge related to the managed care field.

Competencies (KSA's)

• Manages Complexity
• Organizational Savvy
• Directs Work
• Communicates Effectively
• Instills Trust

Knowledge:

• Communication and Media
• Administration and Management
• Customer and Personal Service
• Law and Government
• Education and Training

Skills:

• Active Learning and Listening
• Complex Problem Solving
• Judgment and Decision Making
• Monitoring
• Time Management

Abilities:

• Written Comprehension
• Inductive Reasoning
• Speech Clarity
• Oral Expression
• Problem Sensitivity

Tools & Equipment

• Personal Computer
• Telephone
• Fax Machine
• Printer