Medical Assistance Specialist 4 (MAS4/AHSO) – Non-permanent – Internal

Full Job Description

Medical Assistance Specialist 4 (MAS4/AHSO) – Non-permanent – Internal

71028528

This is a non-permanent position funded through 9/30/2027.

This opportunity is internal and available to current HCA employees only.

This position serves as a lead worker and subject matter expert for a team of call center customer service providers serving Apple Health (Medicaid) customers across the state.

The ideal candidate will have demonstrated skills in leadership, communication, and adaptability.

If you are motivated to support a team providing critical customer service to Washingtonians, 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:

In a call center environment 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.

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:

• Serves as designated Team Lead worker and subject matter expert for all call center line staff - assisting with the resolution of complex client and provider concerns.
• Provides specialist assistance to call center staff as well as Apple Health contracted providers with concerns related to Apple Health client benefit service packages, access to care issues, and provider billing, policy, and payment concerns.

• 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 advises 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.
• Counsels clients on Medical Assistance policies, procedures, and health benefits as outlined in RCW, WAC, and HCA policies and procedures.
• 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.
• Provides second level staff clarification and guidance when dealing with more complex client and provider issues.
• Identifies training requirements, develops Lead and line staff training plans, and assists with training newly hired Medical Assistance Specialists staff.
• Assists with special project assignments as needed to further develop and make modifications to knowledge base policies and procedures.

Qualifications

Required qualifications:

Qualifying candidates will meet one of the following criteria options:

Option 1:

• Bachelor's degree and
• Two years of required experience as described below.

Option 2:

• Associate degree and
• Four years of required experience as described below.

Option 3:

• Six years of required experience as described below.

Option 4:

• One year as a Medical Assistance Specialist 3.

Required experience for this position is defined as:

• 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 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:

• Experience performing conflict resolution with customers.
• Knowledge of Medicaid programs and eligibility
• Experience utilizing Microsoft Office programs such as Outlook, Word, and SharePoint
• Proficient in the use of ProviderOne, Siebel, ACES Online, and Point of Sale

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.

Additional Information

About the 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 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.

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