MEDICARE BUY-IN/ERROR PROCESSING DIRECTOR - 65478

Executive Service

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 a Medicare Buy-In/Error Processing Director in the Compliance & Policy Group within Member Services. This position is a direct report to the Systems & Data Unit Administrator. This position will be indirectly supervising up to 10 staff and directly supervising up to 5 staff. The composition of these staff collectively includes Managed Care Specialist 3 (MCS3), TennCare Program Coordinator (TCPC) and Managed Care Program Manager 2.

The Director will oversee the administration of the Medicare Buy-In Unit and Error Processing Team within the Systems and Data Unit of Member Services which includes Medicare Buy-In eligibility program management, Medicare Buy-In escalation resolution, business process improvement analysis, TEDS-MMIS Reporting analysis, TEDS-MMIS error analysis and resolution, eligibility escalation analysis and resolution, and Medicare related liaison activities with CMS. Using all resources available, the Director will make sound decisions and execute actions necessary to fulfill objectives that support TennCare' s mission and vision.

Lastly, this position will develop effective relationships and strong communication across all units within the Member Services Division, TennCare Business Systems Contractors, and all external stakeholders. Doing so will ensure collaboration and mutual understanding of matters affecting service delivery, policy implementation and Business Systems operational processes.

Key Responsibilities:

• Oversee 1 Unit within Compliance & Policy Group and indirectly supervise up to 10 staff, composed of Managed Care Specialist 3 (MCS3), TennCare Program Coordinator (TCPC) and Managed Care Program Manager 2.
• Oversee the scheduling and preparation of all projects & the daily operations of the unit.
• Oversee the analysis and resolutions actions related to Medicare Buy-In and Eligibility errors.
• Analyze trends related to reported errors and recommend changes to business reporting and/or processes to mitigate the occurrence of the errors.
• Develop departmental objectives and strategies to enhance performance and improve efficiency.
• Ensure processes are standardized, and excellence in customer service is maintained.
• Ensure that there is absolute compliance with all TennCare, CoverKids, state and federal legislation, federal court orders, consent decrees, and policies and procedures are consistently maintained.
• Oversee ongoing team specific training efforts and ensure team acquires and maintains eligibility policy and business knowledge.
• Ensure self-directed daily efforts continue to move TennCare toward a greater place to work.
• Manage the individual performance process including goal evaluation and document review for initial, interim, and annual reviews.
• Provide clear and concise verbal and written communication and guidance to staff in a positive manner.
• Effectively communicate with internal and external customers, peers, TennCare members and applicants.
• Actively engage in developing and implementing team goals, priorities, objectives, and strategies for staff.
• Conduct regular coaching and guidance to ensure staff are meeting goals set forth by the agency and in compliance with TennCare policy and following established business processes.
• Conduct regularly scheduled staff meetings to provide timely feedback, information regarding processes, initiatives, directives, and training opportunities, as well as discuss staff ideas for continuous work process improvement.
• Identify areas of opportunity and provide effective problem-solving techniques to ensure that the areas of opportunity are resolved in a positive manner.
• Build team morale to ensure staff have a positive and inclusive work environment, which leads to higher job satisfaction, and results in greater team efficiencies and effectiveness

Minimum Qualifications:

Education and Experience:

• Graduation from an accredited college or university with a bachelor's degree in a related field and two (2) years of qualifying professional experience.

OR

• Graduation from an accredited college or university with an associate degree in a related field and four (4) years of qualifying professional experience.

OR

• Eight (8) or more years of qualifying professional experience.

OR

• An equivalent combination of education and work experience may be considered

Desirable qualifications:

• 2 years management/supervision experience in either state government, healthcare or eligibility related field.
• Experience with interpreting Medicare policy related to Medicare Savings Plans and Buy-In.
• Ability to exercise sound judgment
• Excellent organizational skills with proven ability to adapt to changing priorities and deadlines, manage workload, and apply creativity to solving complex problems.
• Excellent writing and communication skills required
• Ability to interpret and execute public policy
• Strong research skills, including the ability to locate and analyze documents and integrate information from multiple sources.
• Strong customer service skills, including the ability to problem solve, handle difficult situations, and escalate issues when necessary .
• Ability to coach and mentor a diverse workforce
• Strong work ethic with an ability to receive and implement constructive feedback.
• Strong leadership, decision making skills, critical thinking, problem solving skills, and the ability to understand and clearly communicate complex policy.
• Ability to establish and maintain positive working relationships with a wide variety of internal and external stakeholders and manage multiple projects.

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.