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Job DetailsJob Location: 710 East Texas - Tyler, TX 75703Position Type: Full-TimeEducation Level: High School/ GEDTravel Percentage: No Local Travel (0%)Job Category: Administration & Support ServicesPOSITION OVERVIEW Appeals Specialist gathers and prepares materials for formal appeals, conducts informal reviews, and assists with recoupment efforts when needed. Appeal Specialists communicates with customers to ensure full understanding of appeal requests. Appeal Specialists coordinates with Quality Coordinator II Supervisor and Customer Information and Resource Supervisor on the concerns of the customer’s appeal, reviews for errors, makes recommendations for system improvements. The Appeals Specialist compiles, reviews, and maintains case documentation to support the board appeals process.   Expected Positive Outcomes Compiles and prepares materials for customer appeal of termination/denial of services. Conducts informal appeal reviews. Determines if actions taken were within established rules and procedures. Performs fact finding tasks and prepares materials associated with the outcome of appeals hearing, and potential fraud and exception reports. Tracks and reports on all appeals and outcomes of appeals, and on all potential fraud and exception reports. Maintains the confidentiality of case records. Performs other duties as may be assigned  JOB FUNCTIONS Benchmark Job x Remote Work Eligible  Essential Functions Essential Function Researches and compiles responses for various compliance reports Develops working knowledge of applicable policies, procedures, and processes including local, state, federal and contractual requirements in order to proactively assess assigned organizational compliance Analyzes repeated staff errors and coordinates actions to assist staff in developing methods to prevent recurrence of errors Prepares and presents training materials to staff and coaches staff through awareness sessions and specific training to address monitoring findings Prepares and presents related compliance reports to management identifying areas of noncompliance and maintains complete, organized and accessible compliance records Maintains a master policy and procedures file in a shared drive database containing policy directives and Workforce Development letters Conducts quality and compliance inspections of Child Care case files. Develops and utilizes appropriate tools and processes for monitoring consistency Provides technical assistance to program and administrative staff to document and improve processes; creates and updates process maps and procedures Additional Responsibilities •Performs other duties as assigned Required for All Jobs • Complies with all policies and standards QualificationsPREFERRED/ REQUIRED QUALIFICATIONS Education   Education Level Education Details Required/ Preferred  Bachelor's Degree  from four-year college or university in field related to core duties and responsibilities and one year of experience, Preferred or Associate's Degree  and three years’ experience in field related to core duties and responsibilities Required  Work Experience Experience Experience Details Required/ Preferred  2-4 Minimum of two years of working knowledge of Child Care Services policies, procedures, and regulatory requirements. Required  2-4 Established professional relationship with Board staff, with ability to collaborate effectively across departments. Preferred  Knowledge, Skills and Abilities KSAs Proficiency Intermediate/Advanced analytical skills Proficient Intermediate/Advanced organizational skills Proficient Excellent verbal and written communication skills Proficient Ability to calculate figures and amounts Ability to work with others Proficient Ability to effectively present information and respond to questions both orally and in writing in a manner that is understandable to others Proficient Ability to generate reports and present findings/recommendations Proficient Ability to write clear and accurate correspondence and reports Proficient Ability to fact find with tact, diplomacy and persuasiveness Proficient Ability to calculate figures and amounts Proficient   COMPUTER PROFICIENCY:  • Intermediate experience in Microsoft Word, Excel and Outlook    Licenses and Certifications Licenses/Certifications Licenses/Certification Details Time Frame Required/ Preferred N/A PHYSICAL DEMANDS/WORKING CONDITIONS Physical Demands A thorough completion of this section is needed for compliance with legal standards such as the Americans with Disabilities Act. The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Physical Demand N/A Rarely Occasionally Frequently Constantly Weight Standing    X   Walking    X   Sitting    X   Lifting    X   Carrying    X   Pushing    X   Pulling       Climbing    X   Balancing       Stooping    X   Kneeling    X   Crouching       Crawling       Reaching       Handling       Grasping       Feeling       Talking       Hearing       Repetitive Motions       Eye/Hand/Foot Coordination       Working Environment While performing the duties of this job, the associate is required to work within the selected working environments. Working Condition N/A Rarely Occasionally Frequently Constantly Extreme cold      Extreme heat      Humid      Wet      Noise      Hazards      Temperature Change      Atmospheric Conditions      Vibration      BakerRipley is an equal opportunity employer/program. We do not discriminate in employment on the basis of race, color, religion, sex (including pregnancy and gender identity), national origin, political affiliation, sexual orientation, marital status, disability, genetic information, age, membership in an employee organization, retaliation, parental status, military service, or any status protected by federal, state, or local laws. We are committed to complying with all federal, state, and local laws providing equal employment opportunities, and all other employment laws. Auxiliary aids and services are available upon request for persons with disabilities.
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