Heather Jackson Email & Phone Number

Chattanooga, Tennessee Area

• Collaborates with business owners to facilitate an understanding of what is required by regulation and what the impact may be on various business processes and products.
• Analyzes operational monitoring reports, identifies risk areas and partners with business units to determine remediation opportunities and ensure operational compliance.
• Determines level and type of escalation needed when problems or issues are discovered, develops reporting documents that summarize the activity, analyzes the risk, and a suggest remediation or process improvement.
• Reviews marketing materials, policies, and procedures against regulatory requirements and corporate policy standards

Chattanooga, Tennessee Area

• Review of proposed state issued or federal contract(s), amendment(s), or grant(s).
• Identify contract amendments and ensure the readiness of departments’ implementation of contract amendments issued for the Contractor Risk Agreement (CRA) and the TennCareSelect (TSA) Agreement.
• Monitor departments’ compliance with the requirements set forth in the Contractor Risk Agreement (CRA), the TennCareSelect (TSA) Agreement, and applicable contract amendments.

Chattanooga, Tennessee Area

• Assessment of VSHP business units’ compliance of BlueCare and TennCareSelect contractual requirements, regulations, court decrees, and other mandated statues.
• Track and monitor the status of VSHP Corrective Action Plans (CAPs), recommendations, “agreed action”, and other risk mitigation plans.
• Monitor departments’ compliance with the requirements set forth in the Contractor Risk Agreement (CRA), the TennCareSelect (TSA) Agreement, and applicable contract amendments.

Chattanooga, Tennessee Area

• Assessment of State Directive, Administrative Law Judge Orders, and On Request Reports regarding service and reimbursement appeals. This includes scheduling of appointments, implementing new services, and providing.
• Assessment of services and reimbursement appeal responses regarding compliance with the TennCare Rules, Federal Regulations, and TennCareSelect/BlueCare Contractor Risk Agreement.
• Manage, investigate, analyze and respond to other written and verbal inquiries made from various State agencies within specific timeframes.
• Created and Monitored Appeal Focus Improvement Plans (FIP), VSHP Charters, and Root Cause Analysis.

Chattanooga, Tennessee Area

Chattanooga, Tennessee Area

Chattanooga, Tennessee Area