Administrative Services Assistant

LTSS Ops Appeal Spec (MCS3) - Administrative Services Assistant **This is a onsite position - only candidates in middle Tennessee and able to commute to Nashville, TN regularly will be considered.** The standard work week is 37.5 hrs./wk. The LTSS Operations team is requesting a contractor to assist with Managed Care Specialist level work related to LTSS appeals. Due to the implementation of a new eligibility system, PERLSS, there has been an increase in monitoring for accuracy of notices and letters, which affects appeals, and the time sensitive nature of complying with TennCare Rule and the DOE Consent Decree. PERLSS implementation requirements have increased the workload of existing team members and additional support is needed to maintain daily functions of the appeals team to ensure appeals are handled timely and accurately. The contractor role will allow the appeal team members to manage PERLSS related work, including monitoring and reporting defects, process improvements, and required work related to additional PERLSS implementation phases. Assignments will include processing appeal information timely and entering those into the tracking system, scheduling hearings and tracking rescheduled and continued hearings, providing necessary documentation for parties involved, and assisting with reports. Description of Duties (PROJECT-BASED) Appeal Processing: Documents appeals received in the appropriate tracking system, makes accurate initial appeal determinations within required timeframe by researching and analyzing each appeal request, reviews appeal decisions for accuracy, including identifying duplication, untimely requests, those afforded continuation of benefits and then referring to the appeal nurse reviewer, documents onsite evaluations in tracking system timely, responds to General Counsel questions, and provides any updates and documentation to appropriate parties. 30% Appeal Hearings: Ensures the hearing process is completed and documented in an accurate and timely manner by tracking hearing information in appropriate system, scheduling hearings by the required DOE date, completing all necessary hearing information fields within tracking system, sending Notice of Hearings to parties and documenting notice within system, reviewing for accuracy all ALJ/CD Order Review and implementation, referring all orders to appropriate manager and tracking within appropriate system, and tracking rescheduled and continued hearings. 30% Compliance: Ensures compliance with TennCare Rule and the DOE Consent Decree by reviewing appeal notices for accuracy prior to mailing to applicant and/or designee and external parties, reviewing denial notices for appropriate issuance, providing corrections and mailing correction letters by required deadline and tracking within LTSS system, and ensuring all appeal resolutions are processed accordingly. 25% Reporting: Manage and provide all applicable reports for the LTSS Operations Appeals Unit to internal and external teams, as appropriate. Respond to questions and concerns around reports. 15% Action Plan Timeline The contractor will be needed for nine (9) months. Month 1: Training on new role, including shadowing and completion of new hire onboarding process. Month 2: The contractor will begin working independently, with hands on support and monitoring of supervisor, on appeal related tasks. These include reviewing notices for accuracy, receiving and tracking appeal information, scheduling hearings, and preparing information for hearings. Weekly check ins to occur with supervisor to monitor productivity and answer questions. Months 3-7: The contractor will be fully independent in role and providing support with appeal tasks. This will also include providing required reports, as needed, to supervisor. In months 6 and 7, supervisor and contractor will begin discussing transition plan for tasks, to include a review of eligibility system implementation related tasks that are close to completion or have already been completed. Months 8-9: The contractor will work with appeals team on transitioning responsibilities to team members and finalizing outstanding work tasks. The contractor and supervisor will create a transition plan to minimize transition related gaps, ensuring compliance to Rules and DOE decree. Minimum qualifications 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 Excellent verbal and written communications skills Proven technical skills (e.g. Microsoft Word, Excel, Outlook, PowerPoint, SharePoint, etc.) Excellent time management skills and ability to multi-task and prioritize work in order to meet specific timeframes and deadlines with minimal supervision Keen attention to detail and adherence to deadlines Organization Self-motivated and able to thrive in a fast-paced and results-driven environment Critical thinking and problem-solving skills Location Requirements Candidate must be local. - Candidate Must Be Local Additional Location Details (City, State) : - **This is a onsite position - only candidates in middle Tennessee and able to commute to Nashville, TN regularly will be considered.** Background Verification Minimum Verification Requirements - Please complete the following verifications with Info Cubic upon candidate's selection. Additional verifications may be identified by the agency. TN Standard Background Check Baseline background check Global Monitor Check US Criminal Record Locator w/ Alias Federal Criminal History (7 years) County Criminal History (7 years) National Sex Offender Registry