What are the responsibilities and job description for the Medical Assistance Program Specialist 3 (MAPS3/FS) position at State of Washington Health Care Authority?
Description
Medical Assistance Program Specialist 3 (MAPS3/FS)
71098158
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 Financial Services Division (FSD), in collaboration with other Health Care Authority (HCA) divisions and a variety of external stakeholders and legislative partners, provides strategic financial expertise for Apple Health, Community Behavioral Health (CBH), PEBB and SEBB programs. In addition, FSD oversees the budget and compliance functions necessary to manage and monitor the single largest Washington State individual operating budget. Functions include budget management, accounting, forecasting, professional and hospital rate setting, financial analysis, and payment/collection operations. This division maintains a close working relationship with agency program, policy, and clinical divisions to ensure financially sound implementation and monitoring of program strategies. It is also accountable to the Governor and legislature in ensuring HCA operates within its budget.
About the position:
This Medical Assistance Program Specialist 3 (MAPS3) serves as the agency subject matter expert for all policy matters for the Hospital Safety Net Program (HSNP) and other supplemental payment programs as assigned, which provide supplemental payments for hospital and professional services. The annual value of the HSNP program exceeds $2 billion. The MAPS3 is responsible for stakeholder communications regarding the HSNP and other supplemental payment programs as assigned. This position evaluates federal policy changes, issues, and rule changes from the Centers for Medicare and Medicaid Services (CMS). The position makes operational payment policy determinations and strategic policy recommendations for the prudent purchase of medical care and assists in resolving payment policy conflicts internally with HCA programs. The MAPS3 is responsible for developing standardized documentation that will be used to support the HSNP and other supplemental payment programs as assigned. This position uses analytical thinking for determining program requirements and documentation. This position reviews and updates administrative code, billing instructions, and program documentation.
This position is eligible to telework but is required to report on-site 1-3 days a week during training and to meet business need after. The default assigned work location of all Health Care Authority (HCA) positions – both onsite 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 may choose, but is not required, to support out-of-state telework on a case-by-case basis.
Duties
Some of what you will do:
- Serve as the subject matter expert in the HSNP program and other supplemental payment programs as assigned.
- Plan, design, develop, and maintain a supplemental payment program for inpatient and outpatient hospital providers to provide supplemental payments for inpatient and outpatient services for both fee-for-service (FFS) and Managed Care (MC) enrolled clients.
- Plan, design, develop, and maintain documentation of the HSNP and other supplemental payment programs as assigned, to include program communications, provider inquiries, Washington Administrative Code, policy documentation, and program manuals.
- Review, analyze, and maintain documentation and communication aspects of the HSNP and other supplemental payment programs as assigned, related FFS claim and MC transaction data, and agency expenditures and utilization.
- Formulate technical conclusions on complex issues for rates and payment methods by investigating system operations and payment histories.
- Communicate with providers and industry associations.
- Discuss and recommend strategies for designing supplemental payment systems.
- Confer with federal and state staff regarding the interpretation and evaluation of the proposed changes to adequately access the full effects of federal and state requirements and assure proper implementation.
- Analyze and prepare findings and assurances of compliance with state and federal law and regulations, for state eligibility of federal matching funds and for compliance with agency budget.
Qualifications
Required qualifications:
- Intermediate and above knowledge, skill, and ability using Microsoft Office Suite products.
- Excellent oral and written communication skills, and the ability to develop and conduct trainings, make presentations, and provide direction to a variety of audiences, including professional providers, groups, associations, advocate/community groups, other agencies, managerial staff, and peers.
- Ability to maintain effective working relationships with providers and provide expert consultative services as needed regarding policies, processes, and reimbursement.
- Ability to do complex research requiring the internet or personal interviews.
Qualifying candidates will also meet one of the following criteria options:
Option 1:
- Master’s degree from an accredited college with a major study in health care management, public administration, business administration, accounting, or closely related field.
- Three (3) years’ experience in business, public administration, healthcare management, or accounting programs.
Option 2:
- Bachelor’s degree from an accredited college with a major study in health care management, public administration, business administration, accounting, or closely related field.
- Five (5) years’ experience in business, public administration, healthcare management, or accounting programs.
Option 3:
- Nine (9) years’ experience in business, public administration, healthcare management, or accounting programs.
Option 4:
- One (1) year experience as a Medical Assistance Program Specialist 2 in business, public administration, healthcare management, or accounting programs.
Preferred qualifications:
- Two (2) years of experience in vendor cost reimbursement.
- Four (4) years working experience and in-depth working knowledge of hospital payment methodologies related to Medicaid, Medicare and commercial payers, and federal supplemental payment programs.
- SQL skills.
- Experience with MMIS (ProviderOne) system.
- Ability to perform complex financial analyses using financial data and financial modeling.
- Ability to perform statistical analyses.
- Ability to analyze and interpret Medicare/Medicaid cost reports.
- Advanced project management skills involving stakeholders with varied interests both internal and external to HCA.
- Advanced level knowledge of hospital related claims and billing policy, ICD-10 diagnosis codes and operating procedures, Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS).
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.
Supplemental 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 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.
- Tuition reimbursement
- 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 Angel Matthews at angel.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.
Subscribe to our weekly newsletter to receive a list of new job postings at HCA.
