QUALITY & COMPLIANCE ADMINISTRATOR - 72893

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.

Background Check:

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.

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 Quality & Compliance Administrator in the Compliance and Policy Group within Member Services. This position is a direct report to the Compliance and Policy Group Deputy Director. This position will be overall responsible, indirectly or directly, for up to 25 staff. The composition of these staff collectively includes Director, Assistant Director, Program Manager, Program Coordinators, Managed Care Specialist 3's, and other worker level staff. The Quality & Compliance Administrator will oversee all assigned functions of the Quality and Compliance Unit including the administration of the Payment Error Rate Measurement (PERM), Medicaid Eligibility Quality Control (MEQC), and Comptroller of the Treasury audits, overseeing Public Assistance Reporting Information System (PARIS) inquiry tasks, Inmate Suspension tasks, and federal reporting initiatives. This position requires collaborative work with a variety of internal and external stakeholders to answer questions and resolve concerns related to audits, eligibility processes, PARIS, Inmate Suspension, quality control, federal reporting, and eligibility fraud. Using all resources available, the Administrator 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 within the Member Services Division, the Office of General Counsel, and all external stakeholders. Doing so will ensure collaboration and mutual understanding of matters affecting service delivery and policy implementation.

Key Responsibilities:

• Provide high-quality customer service to the Centers for Medicare & Medicaid Services, the Comptroller of the Treasury, and other external audit-related stakeholders.
• Direct and support all work streams of the Quality and Compliance Unit including federal and state audits, federal reporting, eligibility fraud, and compliance processes.
• Effectuate change across Member Services via case corrections and corrective action plans (CAPs).
• Identify issues affecting member communication, training, eligibility determinations and/or appeals, collaborating with identified stakeholders and propose remedial measures.
• Ensure TennCare is compliant with federal reporting requirements.
• Ensure timeliness, quality, and communication standards are met and/or exceeded by monitoring, assessing, and addressing the team's overall performance.
• Collaborate with peers across the agency to problem solve and create strategic plans and ensure compliance in serving our members.
• Monitor the department's data, reports, compliance audits, and contract deliverables for accuracy, and detection of deviations from trends or expectations.
• Administer the development and submission of programmatic reports and documentation to meet state and federal requirements.
• Perform vendor compliance tasks, as needed.

Minimum Qualifications:

Education and Experience: Graduation from an accredited college or university with a bachelor's degree in a related field and four (4) years of qualifying management experience.

OR

Graduation from an accredited college or university with an associate degree in a related field and six (6) 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: A master's degree in one of the following: business administration, public administration, or public policy

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.