Medical Assistance Specialist 3 (MAS3/CQCT) - Internal

Medical Assistance Specialist 3 (MAS3/CQCT) - Internal Only

71028327

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

Are you ready to make a difference? Join our dynamic team and play a crucial role in advancing our agency’s mission! We are seeking a skilled individual to provide consultative services to both providers and clients while independently determining prior authorization for medical services and equipment. If you’re passionate about improving healthcare delivery and thrive in a fast-paced environment, we want to hear from you! Join us and be part of a team dedicated to making a meaningful impact on the lives of others.

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 mission of Clinical Quality and Care Transformation (CQCT) division is to work together to provide quality services that enhance our client’s ability to obtain and access health care. This position supports the agency and division's mission by providing expert consultative services to providers and clients and independently determining prior authorization of medical services and equipment.

About the position:
This position supports mission of Health Care Authority/Clinical Quality and Care Transformation (CQCT) is to work together to provide quality services that enhance our client’s ability to obtain and access health care. This position supports that mission by providing expert consultative services to providers and clients and independently determining prior authorization of medical services and equipment.

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.

Some of what you will do:

• Based on guidelines, make approval decisions on prior authorization requests and/or route the request to the appropriate clinical staff.
• Correlates data obtained from sources outside the department to build history on specific clients. Determines allowed payment based on manufacturer information and WAC pricing and methodology.
• Communicate with providers to answer questions regarding their requests and educate providers on program policy and/or criteria.
• Provide support to the authorization units through a centralized process by receiving requests and inputting requests into the Provider One system and internal data systems.
• Notify Supervisor/Lead when WAC citations appear to be incorrect, inappropriately applied, or reasons for denial/approval are not clear when received from clinical staff.
• Document coverage decision in Provider One and notify the provider and client of the decision within established WAC timelines as they relate to procession requests and notifying providers and clients is essential.
• Process requests received by fax or mail for Exception to Rule/Limited Extensions (ETR/LE) and individual requests generated by various providers.
• Determine client eligibility and determine if requests require prior authorization based on program rules/guidelines for each request. 
• Review documents to determine if all required documentation was submitted, if not, notify and educate the providers what information is required to submit a request, program rules and what additional information is needed to process requests.
• Refer and/or collaborate with ISD and Provider integrity if specific provider trends are identified where requests seem unusual or inappropriate. Investigate, analyze, or resolve, through collaboration with the Division of Budget and Finance and Provider Relations, claims processing regarding claims issues, pricing problems related to services that are authorized.
• Participate in continual process improvement endeavors and revise, as necessary, prior authorization processes and procedures, database modifications/maintenance and forms development. 
• Stay up to date with the ongoing program changes in Billing Instruction and WAC’s. 
• Participate in multidisciplinary meetings related to reporting, WAC development, Billing Instructions, policy decisions and changes, and program review, to provide a different perspective.
• Train new staff, complete work on special projects and/or assignments. 
• Serve on committees and assist other units within the office as requested.

Required qualifications:

• A bachelor's degree and one (1) year of 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 related experience.

OR

• An associate degree and three (3) years of 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 related experience.

OR

• Five (5) years of 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 related experience.

OR

• One (1) year as a Medical Assistance Specialist 2.

Preferred qualifications:

• Experience and knowledge in the Provider One system (MMIS) and systems such as Document Management Systems, 

• Barcode and ACES, knowledge of medical terminology, Washington Administrative Codes related to prior authorizations and Agency administered programs, and Health Care Authority Medicaid Billing Instructions.
• Ability to use multiple software applications, e.g. Microsoft Word, Microsoft Excel, Microsoft Access, and Outlook.

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. 
• 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 Leila Vandiver at (360) 725-5130 or leila.vandiver@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 : $45,732 - $61,404