VENDOR OPERATIONS COMPLIANCE COORDINATOR - 64088

Tenncare - Nashville, TN

Full-time - Mid Level

Remote - Nashville, TN

About the position

The Vendor Operations Compliance Coordinator at TennCare plays a crucial role in ensuring compliance with Medicaid rules and regulations within the Vendor Operations Group. This position involves validating business processes, conducting audits, and providing training and support to staff. The coordinator will work closely with vendors and internal teams to enhance operational efficiency and improve service delivery for TennCare's members.

Responsibilities

• Provide support and guidance to staff on Medicaid rules, regulations, policies, and procedures.
• Identify areas of opportunity and provide effective problem-solving techniques.
• Validate documented processes to ensure operational accuracy based on current business processes.
• Conduct extensive testing and review of data elements performed by the Call Center.
• Present analytical findings using Excel, PowerPoint, Visio, and other analytical tools.
• Create and maintain training documents for Call Center Business Processes.
• Lead training efforts and address audience questions during presentations.
• Conduct audits of phone calls, tasks, chats, and documents to support service level agreements.
• Analyze audit data to establish trends and determine root causes.
• Prepare reports to document trends and propose corrective actions.
• Resolve member issues by taking appropriate actions when applicable.
• Maintain knowledge of changing policies and processes within the organization.
• Participate in special projects as business needs dictate.
• Build and maintain reporting of semi-complex data in Tableau and Excel.
• Identify risks and opportunities for enhancement within an Omnichannel platform.
• Collaborate with vendors on technical and functional enhancements.
• Validate, test, and track vendor compliance with contractual requirements.
• Draft audit instructions and process guides for State staff and vendors.
• Ensure tasks and audits are processed within designated timeframes.
• Provide clear verbal and written communication and guidance.

Requirements

• Bachelor's degree and 3+ years of full-time professional staff administrative experience or related work.
• An equivalent combination of education and work experience may be considered.
• Advanced knowledge of TEDS and the Medicaid line of business.
• Current extensive working experience with Visio, Curriculum Design, Training, and Policy Implementation.

Nice-to-haves

• Graduation from an accredited college or university with a bachelor's degree and/or equivalent experience in health insurance organizations.
• 2+ years' experience in implementation and/or enhancements of OmniChannel solutions (Amazon AWS, NICE, Five9).
• 1+ years' experience in implementation and/or enhancements of CRM solutions.
• 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.
• Bi-lingual (Spanish) proficiency.
• Advanced skillset in Visio and experience in Training, Curriculum Design, and Policy Implementation.
• 3+ years of presenting data findings to leadership.
• Experience mining, cleaning, and analyzing large datasets in Excel.

Benefits

• Hybrid work environment
• Equitable compensation based on education and experience
• Professional and leadership development opportunities