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Job Description
Job Description
Our client is seeking an Appeals Litigation LEGAL ASSISTANT Representative for the Appeals Operations Group within Member Services. The Appeals Litigation LEGAL ASSISTANT Representative will work to resolve appeals prior to hearing by identifying appeals that are prime for outreach, conducting outreach to explain the position of the state or obtain further information to assist in the processing of appeals. The Appeals Litigation LEGAL ASSISTANT Representative will document actions in TEDS (& other systems) when necessary. Additionally, the Appeals Litigation LEGAL ASSISTANT Representative will ensure that due process standards are met in Medicaid appeals by the accurate and timely processing of appeals and all appeals related documents. Finally, the Appeals Litigation LEGAL ASSISTANT Representative will also work collaboratively with management to identify workflow issues and accomplishments.
Key Responsibilities:
• Ability to maintain a high-volume caseload and adhere to the timeliness standard of appeals while conducting the due process review.
• Assist in the achievement of a high performing and positive work environment that will promote the TennCare Mission.
• Daily receives and reviews appeals for potential resolution within policy guidelines. If a resolution cannot be found, make outreach.
• Conduct outreach to explain the state's actions related to TennCare Medicaid programs and coordinate with other staff for the prompt resolution of appeals where necessary.
• Demonstrates attention to detail in researching appeal cases and documenting notes for proper case processing. Attends and actively participates in all unit meetings and problem-solving discussions for workflow improvements. Ability to
navigate TEDS.
Minimum Qualifications:
Education and Experience: Graduation from an accredited college or university with a bachelor's degree in a related field (preferred degree in business administration, management, public health, health policy, paralegal, or legal assistant studies) and 2 years of
relevant work experience. OR an equivalent combination of education and work experience may be considered.
• 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 time frames and deadlines
• Advanced writing and communication skills
Key Responsibilities:
• Ability to maintain a high-volume caseload and adhere to the timeliness standard of appeals while conducting the due process review.
• Assist in the achievement of a high performing and positive work environment that will promote the TennCare Mission.
• Daily receives and reviews appeals for potential resolution within policy guidelines. If a resolution cannot be found, make outreach.
• Conduct outreach to explain the state's actions related to TennCare Medicaid programs and coordinate with other staff for the prompt resolution of appeals where necessary.
• Demonstrates attention to detail in researching appeal cases and documenting notes for proper case processing. Attends and actively participates in all unit meetings and problem-solving discussions for workflow improvements. Ability to
navigate TEDS.
Minimum Qualifications:
Education and Experience: Graduation from an accredited college or university with a bachelor's degree in a related field (preferred degree in business administration, management, public health, health policy, paralegal, or legal assistant studies) and 2 years of
relevant work experience. OR an equivalent combination of education and work experience may be considered.
• 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 time frames and deadlines
• Advanced writing and communication skills
