What are the responsibilities and job description for the Medical Assistance Specialist 4 (MAS4/AHSO) - Internal Only position at State of Washington?
Medical Assistance Specialist 4 (MAS4/AHSO) - Internal Only
This recruitment will be used to fill multiple positions.
The Medical Assistance Specialist 4 serves as a lead worker supporting Washington State residents in accessing Medicaid, CHIP, and other state-funded programs, bringing expertise in eligibility policy to their team. This role combines conducting hands-on eligibility determinations with training, auditing, and workflow oversight responsibilities.
All HCA employees will apply an equity lens to their work, which may include but is not limited to all analyses of core business and processes.
About the division:
The Apple Health Services and Operations (AHSO) Division works across the HCA and in partnership with the health care community at local, state and federal levels, in order to develop, and manage high quality, and evidence-based health care programs and purchase services that enhance Washington State’s citizens’ ability to access appropriate, quality health care.
About the position:
In a call center environment this position serves as a designated Team Lead worker, as well as staffing the Lead Queue for all MAS3 staff. This position assists line staff, trainers, and management by serving as a subject matter expert – resolving complex client and provider concerns. Escalates urgent client access to care issues, and complex Provider billing, program, policy, and payment concerns to other agency technical and program and policy staff for resolution. Uses all Health Care Authority (HCA) designated reference material, process documents in the MACSC and Lead worker Knowledge Base and references the agency’s Client and Provider based web pages, the ProviderOne Billing and Medical Program Guides, and relevant RCWs and WACs that govern agency policies and procedures. Acts as a liaison between HCA and Apple Health Managed Care case management staff on behalf of Apple Health clients with urgent and emergent access to care issues. This position requires proficiency in the use of ProviderOne, SIEBEL, ACES Online, Point of Sale and Avaya applications. Uses the ProviderOne Help Ticket application, and Health Care Authority program email posts to escalate client and provider concerns to HCA’s technical and policy management as needed to resolve complex issues.
This position is eligible to telework and is typically not required to report on-site. The default assigned work location of all Health Care Authority (HCA) positions – both on-site and telework eligible positions – is within the State of Washington. This position reports to Olympia, WA. Frequency of onsite work will vary based on business and operational needs. All agency employees are required to report on-site in Olympia on their first and last days of employment to pick up and return state-issued equipment, regardless of telework status or location.
Some of what you will do:
- This position is on the team which will be the first assigned when additional special projects that require customer service support are called upon.
- Independently analyzes client eligibility, and makes timely, accurate decisions to assist clients in determining services they qualify for based on their eligibility for Apple Health.
- Counsels and advise clients on scope of care and clients’ rights and responsibilities.
- Resolves questions, complaints and problems about eligibility, accessibility to services, enrollment and other insurance coverage.
- Uses information, questions, and complaints from clients and client advocates to enhance program policy and procedures.
- Provides appropriate consultation to medical providers in order to expedite the reimbursement for title XIX claims submitted to the Health Care Authority for payment.
- Evaluates medical claims for correct adjudication, counsels providers on appropriate billing procedures.
- Researches and identifies workflow and system problems, recommends and implements new/revised procedures.
- Provides second level training for newly released staff trained on client and/or provider Medical Assistance Center skills, processes and procedures.
- Establishes and maintains an effective relationship with Apple Health Medicaid program and policy management to assist providers in solving complex billing concerns.
- Assists with special project assignments as needed to further develop and make modifications to Knowledge base policies and procedures. Provides instruction, assistance, and training to new employees on screening calls, program eligibility, and scope of care and clients’ rights.
- As the lead worker, identifies training requirements, develops Lead and line staff training plans, and assists with training newly hired Medical Assistance Specialists staff.
Required qualifications:
Qualified candidates will satisfy one of the following options:
Option 1:
- Bachelor’s degree and
- Two (2) years of experience as defined below
Option 2:
- Associate degree and
- Four (4) years of experience as defined below
Option 3:
- Six (6) years of experience as defined below
Option 4:
- One (1) year of experience as a Medical Assistance Specialist 3
Qualifying experience includes the following:
- Providing direct client services or counseling of customers in the areas of health insurance, disability, or other related health benefits;
- Public assistance eligibility determination;
- Health insurance premiums/claims processing, adjusting, and investigation;
- Other medical premiums/claims related experience.
Required competencies:
- The ability to take action to learn and grow.
- The ability to take action to meet the needs of others.
Preferred qualifications:
- ACES, HealthPlanFinder, MVP, Provider One and/or Barcode/DMS experience.
How to apply:
Only candidates who reflect the minimum qualifications on their NEOGOV profile will be considered. Failure to follow the application instructions below may lead to disqualification. To apply for this position, you will need to complete your profile which includes three professional references and attach in separate files:
- A cover letter that specifically addresses how you meet the qualifications for this position
- Current resume
To take advantage of veteran preference, please do the following:
- Attach a copy of your DD214 (Member 4 long-form copy), NGB 22, or USDVA signed verification of service letter.
- Please black out any PII (personally identifiable information) data such as social security numbers. Include your name as it appears on your application in careers.wa.gov.
About HCA:
Functioning as both the state's largest health care purchaser and its behavioral health authority, the Washington State Health Care Authority (HCA) is a leader in ensuring Washington residents have the opportunity to be as healthy as possible.
There are three pillars of our work: Apple Health (Medicaid); the Public Employees Benefits Board (PEBB) and School Employees Benefits Board (SEBB) programs; and behavioral health and recovery. Under these pillars, HCA purchases health care, including behavioral health treatment for more than 2.7 million Washington residents and provides behavioral health prevention, crisis, and recovery supports to all Washington residents.
What we have to offer:
- Meaningful work with friendly co-workers who care about those we serve Voices of HCA
- A clear agency mission that drives our work and is person-centered HCA's Mission, Vision & Values
- A healthy work/life balance, including alternative/flexible schedules and mobile work options.
- A great total compensation and benefit package WA State Government Benefits
- A safe, pleasant workplace in a convenient location with restaurants, and shopping nearby.
- And free parking!
Notes:
Prior to a new hire, a background check including criminal record history will be conducted. Information from the background check will not necessarily preclude employment.
HCA is an equal opportunity employer. We value the importance of creating an environment in which all employees can feel respected, included, and empowered to bring unique ideas to the agency. HCA has five employee resource groups (ERGs). ERGs are voluntary, employee-led groups whose aim is to foster a diverse, inclusive workplace aligned with HCA’s mission. Our diversity and inclusion efforts include embracing different cultures, backgrounds and viewpoints while fostering growth and advancement in the workplace. Studies have shown women, racial and ethnic minorities, and persons of disability are less likely to apply for jobs unless they feel they meet every qualification as described in a job description. Persons over 40 years of age, disabled and Vietnam era veterans, as well as people of all sexual orientations and gender identities are also encouraged to apply. If you have any questions about the required qualifications or how your experience relates to them, please contact us at HCAjobs@hca.wa.gov. Persons with disabilities needing assistance in the application process, or those needing this job announcement in an alternative format may contact Angelic Matthews at Angelic.Matthews@HCA.WA.Gov
The Washington State Health Care Authority (HCA) is an E-Verify employer. All applicants with a legal right to work in the United States are encouraged to apply.
E-Verify® is a registered trademark of the U.S. Department of Homeland Security.
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Salary : $52,872 - $71,136