Medical Assistance Specialist 3 (MAS3/MEDS)

Full Job Description

Medical Assistance Specialist 3 (MAS3/MEDS)

71028717

The Medical Assistance Specialist 3 (MAS3) helps ensure that Washington residents get the coverage they need by determining eligibility for Medicaid, CHIP, and other medical assistance programs.

This role will apply federal and state rules, use multiple eligibility systems, and work directly with individuals, families, providers, and teammates to resolve complex cases with care and accuracy.

This position is primarily remote for Washington State residents, with minimal travel and occasional on-site work as needed.

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 Health Care Authority (HCA) of Washington State administers programs that provide health care insurance coverage to over 2 million Washington residents and 400,000 public employees, their dependents, and retirees.

HCA promotes health care access to the uninsured, underinsured and Tribes and has an annual budget of approximately $8 billion dollars.

This position is responsible for supporting the Medical Eligibility Determination Section (MEDS) within the Apple Health Services and Operations (AHSO) Division at the Health Care Authority.

About the position:

The Medical Assistance Specialist 3 supports the HCA mission to provide access to medical care for all eligible Washington citizens.

This position determines initial eligibility and/or ongoing individual and family medical eligibility for Medicaid Title XIX, Children’s Health Insurance Program (CHIP) Title XXI program, and other Medicaid and state funded medical assistance programs available in Washington State.

This position is eligible to telework and is typically not required to report on-site. Minimal travel may be required to attend training, conferences, or events.

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:

• Independently determine initial and/or ongoing eligibility for Health Care Authority Medicaid Title XIX, CHIP Title XXI, and other Medicaid and state funded medical assistance programs administered by the MEDS office,
• Apply complex federal and state eligibility regulations published in WAC and RCW to specific household circumstances resulting in accurate eligibility decisions.
• Use and manage multiple interdependent electronic systems including but not limited to the Automated Client Eligibility System (ACES), HealthPlanFinder, ProviderOne,Microsoft Office, SOLQ, and Employment Security Department (ESD).
• Analyze, research and resolve complex eligibility issues applying proper rules and procedures with a high degree of independence.

Conduct interviews over the telephone, in person, and/or through written correspondence with clients, providers and/or third parties to obtain information for required documentation and verification to support program eligibility.

Establish effective working relationships with clients and their advocates and manage difficult interactions with tact and diplomacy.

• Work with individual Family Planningproviders to answer inquiries and resolve issues related to eligibility for the Family Planning program.
• Work in partnership with advocates, providers, Heath Benefit Exchange, other state agencies, community-based organizations and other units within HCA to provide clarification, resolve disputes, solve problems, coordinate referrals and/or answer inquiries.

Using excellent written and oral communication skills, apply effective customer service techniques and principles to all interactions with customers, their advocates, and other stakeholders.

Maintain current and thorough knowledge of rules of eligibility for Medicaid programs, managed care and other areas in the Health Care Authority to provide comprehensive responses to questions or concerns from the public and our customers.

• Take part in training and other development opportunities to enhance communication skills.
  

Qualifications

Required qualifications:

Qualifying candidates will meet one of the following criteria options:

Option 1:

Bachelor's degree in a field identified above, and one (1) year of the required experience below

Option 2:

Associates degree and (3) years of the required experience below

Option 3:

Five years of the required experience below

Option 4:

One year as a Medical Assistance Specialist 2

The required experience includes one or more of the following:

• Experience 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, or other medical premiums/claims/eligibility related experience.
• 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.

Required competencies:

• The ability to take action to learn and grow.
• The ability to take action to meet the needs of others.

Preferred qualifications:

• Experience performing conflict resolution with customers.
• Knowledge of Medicaid programs and eligibility.
• Experience utilizing Microsoft Office programs such as Outlook, Word, and SharePoint.

How to apply:

Only candidates who reflect the required 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:

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 four 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 support 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:

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 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 Lisa Fleming at (360) 725-1723 or lisa.fleming@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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