VENDOR OPERATIONS COMPLIANCE COORDINATOR - 64088

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 Vendor Operations Compliance Coordinator in the Vendor Operations Group within Member Services. The position requires the Compliance Coordinator to have an advanced working knowledge of TEDS and the Medicaid line of business. This position also requires the Compliance Coordinator to have current extensive working experience with Visio, Curriculum Design, Training, and Drafting and Implementing Policy. They will work under immediate supervision of the Vendor Operations Technical Director to perform validation efforts on Call Center Business processes, perform audits, process tasks/applications and identify Business Process improvement opportunities.

The Vendor Operations Compliance Coordinator will effectively communicate, establish, and maintain working relationships with vendors, applicants, members, families, facilities, and Authorized Representatives as needed to relay clear information and expectations of the information needed for an accurate eligibility determination. Lastly, the Vendor Operations Compliance Coordinator will work collaboratively and proactively with the Vendor Operations Technical Director to identify areas of opportunity to create quality and process improvement plans, develop routine and ad hoc reporting, and lead technology enhancement development through comprehensive data and program analytics.

Key Responsibilities:

• Provide support and guidance to staff on matters relating to Medicaid rules, regulations, policies, and procedures.
• Identify areas of opportunity and provide effective problem-solving techniques to ensure that the areas of opportunity are resolved in a positive and accurate manner.
• Validate all systems documented processes that align with the Call Center are operationally accurate based on current business processes. Validation includes but not limited to extensive testing and review of data elements performed by the Call Center in Applications such as TEDS, Interchange, NICE, Document Center, SNOW and any software application used by the Call Center.
• Present analytical findings by use of Excel, Power Point and Visio and other analytical based software tools.
• Create clear and concise training documents that support current Call Center Business Processes. All such training tools will be developed, presented, and maintained by the Compliance Coordinator. The Compliance Coordinator will be required to lead training efforts and address questions to the audience they are presenting to.
• Conduct audits of phone calls, tasks, chats, and documents in support of Contract service level agreements.
• Analyze audit data to establish trends and determine root causes.
• Prepare reports to document trends and propose corrective actions.
• Complete tasks and reviews within appropriate databases
• Resolve member's issues by taking the appropriate action when applicable.
• Maintain knowledge of changing policies and processes within the organization
• Participate in other special projects as business needs dictate.
• Build and maintain reporting of semi-complex data leveraged to make business decisions in Tableau and Excel.
• Identify areas of risk and opportunities for enhancement within an Omnichannel platform (Amazon AWS, NICE, Five9) and CRM solution.
• Collaborate with Vendors on design and implementation of technical and functional enhancements.
• Validate, test, and track Vendor compliance with Contractual Technical and Functional requirements related to OmniChannel telephony systems (Amazon AWS, NICE, Five9) and CRM requirements.
• Draft step-by-step audit instructions and process guides to be leveraged by State staff and Vendors.
• Ensure tasks and audits are processed within the designated timeframe.
• Provide clear and concise verbal and written communication and guidance in a positive manner.

Minimum Qualifications:

• Bachelor's degree and 3+ years of full-time professional staff administrative experience or related work

OR

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

Desirable qualifications:

• Graduation from an accredited college or university with a bachelor's degree and/or experience equivalent to five years of professional level experience interpreting policy or procedural provisions for a TennCare, Medicaid, Managed Care, or other related health insurance organization, or supervising professional staff who deal with health insurance.
• 2+ years' experience in implementation and/or enhancements of OmniChannel solutions (Amazon AWS, NICE, Five9) including, but not limited to, IVR, call routing, reporting, and dashboards.
• 1+ years' experience in implementation and/or enhancements of CRM solutions including customization and leveraging APIs
• 1 Year experience creating and maintaining Tableau Dashboards
• 1 Year experience working in JMP, Interchange, SOLQ, or similar data software.
• 2 years of eligibility experience within TennCare Member Services. Advanced knowledge of working in TEDS specifically with the handling/processing of tasks and applications.
• Extensive Medicaid line of Business experience.
• Bi-lingual (Spanish)
• Advanced skillset and actively using Visio.
• Advance experience with Training, Curriculum Design and Drafting and Implementing Policy.
• 3 + years of presenting data findings to leadership.
• Experience mining, cleaning, and analyzing large datasets including numerical and text data in Excel.
• Advanced Excel skills including, but not limited to Graphing, Pivot Tables, and Formulas (logical, mathematical, and statistical)

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.