LTSS Specialist I Nashville, TN/en-US/External/job/Nashville-TN/LTSS-Specialist-I_R-13599/applyThis is a multifaceted position responsible for authorizations, service delivery and provider inquiries for the CHOICES and Employment & Community First (ECF) CHOICES Programs. The LTSS Specialist I will work in partnership with Care Coordinators and Support Coordinators to promote interdependent collaboration with the member, physician/primary care manager, family, and other members of the Care and Support Coordination Teams. The LTSS Specialist I will also provide outreach to members to ensure continuity of care. Job Description: Job Duties & Responsibilities * Manage services on person center support plan for members, issue authorizations and verify authorizations for services. * Collaborate with Care Coordinators/Support Coordinators to ensure accurate service provision. * Review and complete reports as directed by management. * Ensure compliance with contractual obligations and government regulations are sustained to avoid penalties. * Perform quality analyses of person center support plans. * Works cross-functionally to resolve authorization and payment issues. * Work with Team Lead/Management to ensure appropriate decisions are made on incoming calls and emails from Members/Providers/Care and Support Coordinators. * Other projects, duties or responsibilities assigned by Management. Job Qualifications Education * High School Diploma or equivalent required. Experience * 2 years experience in a health care environment in authorizations, claims processing/ adjustments or customer service required. Skills/Certifications * Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint) * Proficient oral and written communication skills * Proficient interpersonal and organizational skills * Ability to work within specified timeframe requirements. * Knowledge of resources for CPT, HCPCS, ICD, and UB-92 coding is required. * Must be well organized and have experience in managing multiple assignments with critical deadlines. Job Specific Requirements: Job Specific Qualifications Healthcare and/or managed care experience highly preferred LTSS and/or CHOICES experience preferred Number of Openings Available: 1 Worker Type: Employee Worker Sub-Type: Regular Company: VSHP Volunteer State Health Plan, Inc BCBST is an Equal Opportunity employer (EEO), and all employees and applicants will be entitled to equal employment opportunities when employment decisions are made. BCBST will take affirmative action to recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or membership in a historically under-represented group. BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means. Tobacco-Free Hiring Statement To further our mission of peace of mind through better health, effective 2017, BlueCross BlueShield of Tennessee and its subsidiaries no longer hire individuals who use tobacco or nicotine products in any form in Tennessee and where state law permits. A tobacco-free hiring practice is part of an effort to combat serious diseases, as well as to promote health and wellness for our employees and our community. All offers of employment will be contingent upon passing a tobacco/nicotine test. An individual whose test result is positive for tobacco/nicotine will be disqualified from employment and the job offer will be withdrawn. Individuals who fail the tobacco/nicotine screening will be permitted to reapply for employment after 6 months, if tobacco/nicotine-free. Resources to help individuals discontinue the use of tobacco/nicotine products include smokefree.gov or 1-800-QUIT-NOW. Posted 3 Days AgoFull timeR-13599 About Us As Tennessee's largest health benefit plan company, we've been helping Tennesseans find their own unique paths to good health for over 65 years. More than that, we're your neighbors and friends fellow Tennesseans with deep roots of caring tradition, a focused approach to physical, financial and community good health for today, and a bright outlook for an even healthier tomorrow.