Health Benefits Specialist 3 (MAS3/AHSO) – Project

Full Job Description

Health Benefits Specialist 3 (MAS3/AHSO) – Project

These are project positions funded through 09/30/2027.

This recruitment may be used to fill multiple positions.

This position works in a customer service and call center environment to explain medical benefit scope of care, enroll Washington Apple Health (Medicaid) clients into managed care plans, resolve procedural problems involving clients, insurance carriers, or providers, and research to resolve complex inquiries regarding claims, problems, and conflicts in the Medical Assistance Customer Service Center (MACSC).

If you enjoy providing excellent customer service via phone, learn quickly, and demonstrate strong problem-solving skills, this may be the position for you.

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 Health Care Authority (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:

This position is responsible for supporting Medical Assistance Customer Service Center (MACSC) within the AHSO Division at HCA that provides consultative services to clients, providers, and other external customers.

Explains scope of care in regard to medical benefits, enrolls Washington Apple Health (Medicaid) clients into managed care plans.

Resolves procedural problems involving clients, insurance carriers or providers, researches and resolves complex inquiries regarding claims, problems, and conflicts.

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. HCA has currently suspended the ability to support out-of-state telework.

Requirements

Some of what you will do:

• Provides expert consultation to clients, providers, Managed Care Organizations (MCO), local community service offices (CSO), and stakeholders regarding benefits and services provided by the Apple Health (Medicaid) program, and other state programs via toll-free lines and written correspondence.
• Counsels and advises customers on Health Care Authority (HCA) policies, scope of care, clients’ rights and responsibility, and Medical Assistance policy, procedure, and health benefits.
• Tactfully manages difficult situations and provides quality customer service.
• Coordinates service referral, eligibility information, and managed care membership information between managed care plan, local community services offices, other state agencies, community service organizations, and medical and social services providers.
• Assists customers in resolving disputes and other issues related to their benefit service package or managed care plan, reissues services card, and provides self-service resources.
• Resolves complex questions, claims issues, complaints and problems about eligibility, accessibility to services, enrollment, and other insurance coverage.
• Assists customers in determining managed care eligibility, selecting and enrolling in or changing managed care plans, and resolving issues regarding client health care choices and access to medical services.
• Analyzes, evaluates, and assists with claims submission for medical and social service providers for correct adjudication and provider payment.
• Utilizes excellent written and oral communication skills, applies effective customer service techniques and principles, and maintains a thorough knowledge of ProviderOne (P1), Point-Of-Sale pharmacy claims processing system (POS), Automated Client Eligibility System (ACES), Treasury Management System (TMS), Siebel Contact Management System and Siebel and Avaya soft phone, State and Federal Title XIX policy, managed care programs, HealthPlanfinder application (Health Benefit Exchange System), and medical terminology.

Qualifications

Required qualifications:

Qualified candidates will satisfy one of the following criteria options:

Option 1:

• Bachelor’s degree and
• One year of the experience defined below

Option 2:

• Associate degree and
• Three years of the experience defined below

Option 3:

• Certificate of Medical Billing and Coding or closely related certificate program and
• Three years of the experience defined below

Option 4:

• Five years of the experience defined below

Option 5:

• One year as a Medical Assistance Specialist 2.

The experience required is one or a combination of 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/eligibility related experience; or
• experience researching and analyzing complex rules, regulations, or policies and utilizing research and analysis to make determinations, solve problems, or complete work while providing direct customer service either in person or on the telephone.

Preferred qualifications:

• Experience in assisting medical and social services providers with inquiries about billing, authorization, payment, denial, and adjustment of claims that are submitted to ProviderOne payment system.
• Computer skills, knowledge of ACES, P1, Siebel, and Medicaid programs.
• Ability to consistently provide excellent customer service during a full shift of continuous phone calls within a toll-free customer service center.
• Ability to manage information arising out of conflicting rules and procedures that are established by other sections.
• Ability to manage stress arising out of diverse conflicts and the demands of customers to provide the correct resolution of issues within a short period of time.
• Ability to counsel and placate customers’ expectations when they are different from the policy and regulations under Washington Administrative Code.

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:

• 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.

Additional Information

About HCA:

The Washington State Health Care Authority (HCA) is committed to whole-person care, integrating physical health and behavioral health services for better results and healthier residents.

HCA purchases health care for more than 2.5 million Washington residents through Apple Health (Medicaid), the Public Employees Benefits Board (PEBB) Program, and the School Employees Benefits Board (SEBB) Program.

As the largest health care purchaser in the state, we lead the effort to transform health care, helping ensure Washington residents have access to better health and better care at a lower cost.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.
• Tuition reimbursement
• And free parking!

Notes:

This position is covered by the Washington Federation of State Employees (WFSE). Once the listed position(s) is(are) filled, this recruitment announcement may also be used to fill additional position(s) for up to sixty (60) days.

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 Jake Nelko at jake.nelko@hca.wa.gov or 360.725.0945.

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.

Subscribe to our weekly newsletter to receive a list of new job postings at HCA.