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 acceptable forms of proof of compliance to the Bureau of TennCare. • 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