Medical Assistance Specialist 4 (MAS4/ERB) - Internal

Description

Medical Assistance Specialist 4 (MAS4/ERB) - Internal

71089396

This opportunity is available to current HCA employees only.

Join the Health Care Authority as a key player in supporting the PEBB and SEBB Programs! In this role, you'll provide top-notch customer service, guide staff through complex eligibility and enrollment issues, and ensure policy accuracy. You’ll also have the chance to coordinate with the Accuracy and Internal Training team in training and mentoring new and existing staff. With telework flexibility, you’ll enjoy a great work-life balance as you make a real difference in the lives of program members. If you have strong communication and leadership skills, plus experience with systems like PAY1, this is a fantastic opportunity to grow your career.

All HCA employees will apply equity lens to their work, which may include but is not limited to all analyses of core business and processes.

About the division:

The Washington State Health Care Authority (HCA) is the state's largest healthcare purchaser and behavioral health authority, dedicated to ensuring residents have access to comprehensive health care. Its three core pillars include Apple Health (Medicaid), the Public Employees Benefits Board (PEBB), and the School Employees Benefits Board (SEBB), along with behavioral health and recovery services. The Employees and Retirees Benefits (ERB) Division manages a $5 billion budget and provides insurance coverage for over 725,000 lives through PEBB and SEBB programs, offering health benefits to state employees, retirees, school employees, and their dependents. Both programs focus on value-based purchasing and align with the Triple Aim of better health, better care, and better costs.

About the position:

This position supports the mission of the Health Care Authority (HCA) and aligns with the Governor's health care priorities by delivering quality customer service to PEBB and SEBB Programs’ subscribers and dependents, including retirees, COBRA participants, and K-12 members, addressing complex questions related to eligibility and enrollment. Key responsibilities include serving as first-call resolution staff for members’ escalated calls from ERB Division Customer Service MAS3s, answering inquiries and complaints by correspondence, HCA Support, phone and in-person, assisting MAS3’s in interpreting WACs, policies, procedures, and ERB practices while also providing feedback to staff about their work to ensure accuracy and quality. This role also serves as a back-up to the Medical Assistance Specialist 5, including attending meetings as needed.

This position is eligible to telework but is required to report on-site 1-2 days a week to meet business need. 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 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:

• Provide lead support to ERB Division Customer Service MAS3s, as well as other ERB Division staff in person, email, and in Teams messaging.
• Serve as first-call resolution staff for members’ escalated calls from ERB Division Customer Service MAS3s.
• Provide instruction, guidance, and assistance to PEBB and SEBB Programs members, agency representatives, and external stakeholders, such as health plans, in resolving unique and complex problems related to all PEBB and SEBB insurance benefits (retiree, COBRA, continuation coverage, K-12, Dependent Verification, Premium Surcharges, Eligibility Verification, etc.).
• Answer inquiries and complaints by correspondence, HCA Support, phone, and in-person within 72 hours of receipt.
• Maintain current and thorough knowledge of WACs as they apply to the PEBB and SEBB Programs, to provide comprehensive and accurate responses to internal and external stakeholders.
• Assist ERB Division Customer Service MAS3s in interpreting WACs, PEBB and SEBB Programs ‘policies, and ERB Division Customer Service standards, procedures, operational processes, and regular practices. Provide regular feedback and guidance on MAS3s’ work.
• Work as a main contact and advisor, including overseeing that MAS3s are following their schedules, as assigned by the ERB Division Customer Service Scheduler.
• Consult with other ERB Division Customer Service MAS4s and/or staff from the ERB Division Accuracy and Internal Training area, if necessary, to ensure accurate information is provided.
• Oversee lobby customer service duties and assist staff as needed, including acting as lobby and phone back up assisting members as required.
• assisting the ERB Division Customer Service MAS5 supervisor with special projects relating to day-to-day operations, process development, and implementation.
• Assist the ERB Division Accuracy and Internal Training area with training and mentoring staff in all areas of PEBB and SEBB insurance, system tools, and resources needed to accurately interpret WACs and procedures. Assist with phone coaching, procedure drafting, reviews, and revisions.
• Complete special assignments that affect day-to-day operations assigned by the ERB Division Customer Service MAS5 supervisor.
• Attend and complete training courses as directed by agency and supervisor. Other duties as assigned.

Qualifications

Required qualifications:

Qualifying candidates will meet one of the following criteria options:

Option 1:

Bachelor's degree in a closely related field, andtwo (2) years of the required experience below

Option 2:

Six (6) years of the required experience below

Option 3:

One year as a Medical Assistance Specialist 3

The required experience includes:

• 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 process, adjusting, and investigation
• Other medical premiums/claims related experience

Preferred qualifications:

• Knowledge of both PEBB & SEBB Programs’ information sources, including WACs, policies, and procedures.
• Superior skills in communication, customer service, time management, and interpersonal relations.
• Ability to achieve results independently and stay calm during stressful circumstances.
• Use tact and diplomacy in correspondence or direct contact with internal or external stakeholders.
• Demonstrated lead experience with the ability to make valid work decisions regarding complex eligibility determinations, inquiries, and policy matters.
• Experience using the PAY1 and Benefits 24/7 systems and other database and software programs.
• Assist in conducting staff meetings, train and instruct others, evaluate performance, and develop employee potential.
• Ability to handle and organize competing priorities, multiple deadlines, and achieve results independently.

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:

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 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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More than Just a Paycheck!
Employee benefits are not just about the kind of services you get, they are also about how much you may have to pay out of pocket. Washington State offers one of the most competitive benefits packages in the nation.

We understand that your life revolves around more than just your career. Like everyone, your first priority is ensuring that you and your family will maintain health and financial security. That's why choice is a key component of our benefits package. We have a selection of health and retirement plans, paid leave, staff training and other compensation benefits that you can mix and match to meet your current and future needs.

Read about our benefits:
The following information describes typical benefits available for full-time employees who are expected to work more than six months. Actual benefits may vary by appointment type or be prorated for other than full-time work (e.g. part-time); view the job posting for benefits details for job types other than full-time.

Note: If the position offers benefits which differ from the following, the job posting should include the specific benefits.

Insurance Benefits
Employees and their families are covered by medical (including vision), dental and basic life insurance. There are multiple medical plans with affordable monthly premiums that offer coverage throughout the state.

Staff are eligible to enroll each year in a medical flexible spending account which enables them to use tax-deferred dollars toward their health care expenses. Employees are also covered by basic life and long-term disability insurance, with the option to purchase additional coverage amounts.

To view premium rates, coverage choice in your area and how to enroll, please visit the Public Employees Benefits Board (PEBB) website. The Washington Wellness program from the Health Care Authority works with PEBB to support our workplace wellness programs.

Dependent care assistance allows the employee to save pre-tax dollars for a child or elder care expenses.

Other insurance coverage for auto, boat, home, and renter insurance is available through payroll deduction.

The Washington State Employee Assistance Program promotes the health and well-being of employees.

Retirement and Deferred Compensation
State Employees are members of the Washington Public Employees' Retirement System (PERS). New employees have the option of two employer contributed retirement programs. For additional information, check out the Department of Retirement Systems' web site.

Employees also have the ability to participate in the Deferred Compensation Program (DCP). This is a supplemental retirement savings program (similar to an IRA) that allows you control over the amount of pre-tax salary dollars you defer as well as the flexibility to choose between multiple investment options.

Social Security
All state employees are covered by the federal Social Security and Medicare systems. The state and the employee pay an equal amount into the system.

Public Service Loan Forgiveness
If you are employed by a government or not-for-profit organization, and meet the qualifying criteria, you may be eligible to receive student loan forgiveness under the Public Service Loan Forgiveness Program.

Holidays
Full-time and part-time employees are entitled to paid holidays and one paid personal holiday per calendar year.

Note: Employees who are members of certain Unions may be entitled to additional personal leave day(s), please refer to position specific Collective Bargaining Agreements for more information.

Full-time employees who work full monthly schedules qualify for holiday compensation if they are employed before the holiday and are in pay status for at least 80 nonovertime hours during the month of the holiday; or for the entire work shift preceding the holiday.

Part-time employees who are in pay status during the month of the holiday qualify for the holiday on a pro-rata basis. Compensation for holidays (including personal holiday) will be proportionate to the number of hours in pay status in the month to that required for full-time employment, excluding all holiday hours. Pay status includes hours worked and time on paid leave.

Sick Leave
Full-time employees earn eight hours of sick leave per month. Overtime eligible employees who are in pay status for less than 80 hours per month, earn a monthly proportionate to the number of hours in pay status, in the month to that required for full-time employment. Overtime exempt employees who are in pay status for less than 80 hours per month do not earn a monthly accrual of sick leave.

Sick leave accruals for part-time employees will be proportionate to the number of hours in pay status, in the month to that required for full-time employment. Pay status includes hours worked, time on paid leave and paid holiday.

Vacation (Annual Leave)
Full-time employees accrue vacation leave at the rates specified in WAC 357-31-165(1) or the applicable collective bargaining agreement (CBA). Full-time employees who are in pay status for less than 80 nonovertime hours in a month do not earn a monthly accrual of vacation leave.

Part-time employees accrue vacation leave hours in accordance with WAC 357-31-165(1) or the applicable collective bargaining agreement (CBA) on a pro rata basis. Vacation leave accrual will be proportionate to the number of hours in pay status, in the month to that required for full-time employment.

Pay status includes hours worked, time on paid leave and paid holiday.

As provided in WAC 357-58-175, an employer may authorize a lump-sum accrual of vacation leave or accelerate the vacation leave accrual rate to support the recruitment and/or retention of a candidate or employee for a Washington Management Service position. Vacation leave accrual rates may only be accelerated using the rates established WAC 357-31-165.

Note: Most agencies follow the civil service rules covering leave and holidays for exempt employees even though there is no requirement for them to do so. However, agencies are required to adhere to the applicable RCWs pertaining holidays and leave.

Military Leave
Washington State supports members of the armed forces with 21 days paid military leave per year.

Bereavement Leave
Most employees whose family member or household member dies, are entitled to three (3) days of paid bereavement leave. In addition, the employer may approve other available leave types for the purpose of bereavement leave.

Additional Leave
Leave Sharing
Parental Leave
Family and Medical Leave Act (FMLA)
Leave Without Pay

Please visit the State HR Website for more detailed information regarding benefits.

Updated 12-31-2022