OFH PLEADING LEGAL ASSISTANT - 79002

Executive Service

OFH PLEADING LEGAL ASSISTANT Division of TennCare Chief Medical Office (CMO) Nashville, TN Minimum Annual Salary $48,684.00 Closing Date: 08/17/2026

Background Check

This position requires a criminal 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

• Tenn
• Care 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.
• Tenn
• Care provides coverage for approximately 1.7 million Tennesseans and operates with an annual budget of approximately $19 billion.
• It is run by the Division of Tenn
• Care with oversight and some funding from the Centers for Medicare and Medicaid Services (CMS).
• Tenn
• Care'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 Tenn
• Care has on the lives of the most vulnerable Tennesseans, Tenn
• Care employees report that their work provides them with a sense of meaning, purpose, and accomplishment.
• Tenn
• Care leadership understands that employees are our most valuable resource and ensures professional and leadership development are a priority for the agency.

Job Overview

TennCare compensation is equitable and will be based on education and experience for a qualified candidate in accordance with Department of Human Resources (DOHR) policy.

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.

• Tenn
• Care is committed to improving the quality of health care for its members while maximizing the value of every dollar spent.
• Since its founding, Tenn
• Care has been a leader in innovation through clinical care models and delivery system payment reform.
• Tenn
• Care's Medical Office is integral to this mission by leading clinical and quality oversight and strategic innovation for the agency.
• The medical office is responsible for all medical, dental, behavioral health and pharmacy policy, operations, and appeals as well as quality improvement and population health programming.
• When a Tenn
• Care Managed Care Contractor (MCC) makes an adverse benefit determination affecting one of their assigned Tenn
• Care enrollees, the enrollee has the right to appeal the determination to Tenn
• Care.
• If Tenn
• Care upholds the MCC's determination, agreeing that the benefit-under-appeal is not medically necessary under Tenn
• Care rules, then the enrollee's appeal is set for administrative hearing.
• The Office of Fair Hearings (OFH) & Post-Hearing Appeals and Directives (Post) consists of attorneys and legal support staff who facilitate the administration of administrative hearings.
• OFH pleading legal assistants support attorneys who represent Tenn
• Care at administrative hearings for medical, dental, and behavioral member appeals.

Key Responsibilities

The Legal Assistant is responsible for

• Electronically filing court documents with the Administrative Procedures Division of the Secretary of State's Office, including Notices of Hearings, Amended Notices of Hearings, Supplements, Motions, Exhibits, and other related documents. This includes retrieving file-stamped copies from APD and uploading them into the Medical Appeals Tracking System (MATS).
• Conducting outreach to Members to clarify issues related to their appeals and to obtain and document supporting information.
• Researching and gathering documents related to each Member's medical appeal through communication with TennCare's Managed Care Contractors.
• Ensuring compliance with all relevant laws, regulations, criteria, and policies that pertain to each appeal.
• Monitoring workflow within the Medical Appeals Tracking System (MATS) by managing Tasks associated with assigned appeal cases.
• Preparing and maintaining Proof of Service for upcoming hearings by verifying the receipt of mailed documents and providing sworn declarations when necessary.
• Legal Assistants in the Office of Fair Hearings work in collaboration with OFH Hearing Attorneys. Daily and weekly tasks may vary based on the specific needs of each attorney and individual cases.

Minimum Qualifications

Education and Experience

Education equivalent to graduation from an accredited college, university, or professional school with one of the following: (1) an Associate's Degree in Paralegal or Legal Assistant studies; (2) a Bachelor's Degree in Paralegal or Legal Assistant studies; (3) a Paralegal Certificate; or (4) one year (28 semester hours) of graduate level law school.

OR

Education equivalent to graduation from a standard high school and two years of full-time experience in researching legal issues and documenting findings to assist in building case files, settling legal disputes, and/or providing legal counsel to clients.

Desirable Qualifications

• Experience with MATS, TEAMS, MS Office, Outlook, Adobe, Excel and other database applications
• Experience reviewing medical records and/or health insurance denials -An equivalent combination of education and work experience may be considered.
• Ability to maintain excellent professional and inter-personal relationships and the ability to multi-task when priorities are changed and be amenable to assuming a wide variety of special assignments as directed.
• Ability to prioritize conflicting needs, handle matters expeditiously and proactively, and follow-through on projects to successful completion within established deadlines.
• Must be detail oriented and have demonstrable organization, facilitation, and communication skills.
• Must have strong written communication, writing letters, emails, and reports on behalf of the office staff.

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.