COBCO Health Insurance Specialist (MAS3/AHSO)

State of Washington•Olympia, WA

44d•Remote

About The Position

This position investigates and researches cases of Medicaid billing to determine whether third party liability coverage should have been used. The goal of this work is to ensure that Medicaid has been the payer of last resort, to ensure proper use of these public funds. This work requires delving into situations to find new information and wade through ambiguity with a goal of ensuring medical costs being covered by the correct entities. If you are a problem solver who likes to ask questions and dig deep to uncover issues or explore curiosities, 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 organization's mission is to provide high quality health care through innovative health policies and purchasing strategies. 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: This position resides in the Health Insurance Unit (HIU) within the Coordination of Benefits and Claims Office (COBCO) and supports HCA's vision for a healthier Washington via both health purchasing strategies as well as customer-centered service. This position investigates and verifies potential third party liability (TPL) coverage leads and integrates third party liability coverage into the ProviderOne MMIS, to ensure cost avoidance or cost recovery of Medicaid expenditures, assuring Medicaid will be the payer of last resort. TPL refers to the legal obligation of third-party health care sources to pay for a claim for a Medicaid client before Medicaid pays the claim. In this position, staff independently provide expert consultative services to providers and clients, both orally and in writing, concerning coordination of TPL and Medicaid benefits. 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

Qualifying candidates will meet one of the following criteria options: Option 1: Bachelor's degree and One year of the experience defined below. Option 2: Associate degree and Three years of the experience defined below. Option 3: Certificate of Medical Billing and Coding, or a closely related certificate program, and Three years of the experience defined below. Option 4: Five years of the experience defined below. Option 5: One year as a Medical Assistance Specialist 2. Qualifying experience 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; other medical premiums/claims/eligibility related experience; or 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.
The ability to take action to learn and grow.
The ability to take action to meet the needs of others.

Nice To Haves

Demonstrated experience with: Communicating with external parties to acquire or understand complex information
Navigating web sites and online resources to perform research and make decisions
Writing correspondence on complex topics in a way that makes concepts clear to the recipient
Navigating complex problems for which there may be incomplete information or context
Microsoft products (Outlook, OneNote, Excel, Teams, Word, etc)
Strong oral and written communication skills while providing excellent customer service
Resolving complex complaints, problems, and conflicts with clients, providers and insurance companies
Critical thinking skills; use good judgment in evaluating situations and making decisions
Private commercial insurance coverage benefits and eligibility
Independently performing a wide range of technical duties with limited supervisory direction
ProviderOne, Barcode, Service Now (SNOW), and ACES Online
Commitment to collaboration, clear communication, and shared success
Knowledge of: Private commercial insurance coverage and eligibility verification
Medical terminology, procedure and diagnosis codes, and pharmacy billing
Medical billing and insurance claim processes and claims adjudication
Medical terminology, procedure and diagnosis codes, pharmaceutical usage
Medicaid programs and eligibility
Demonstrated ability to: Analyze medical and dental coverage details and make appropriate determinations
Understand and apply procedures, policies, and guidelines
Learn new and/or increasingly complex tasks
Work effective together with a commitment to collaboration, clear communication, and shared success

Responsibilities

Makes complex judgments and payment determinations in accordance with state and federal law and regulations and HCA policy.
Investigates and analyzes insurance documents, reports, files, and other resources to determine private health insurance benefits and eligibility.
Accesses ProviderOne subsystems, and updates and maintains control files used to adjudicate claims and determine Managed Care enrollment eligibility.
Recovers funds from insurers when a private health insurer is liable for costs incurred by a Medicaid eligible individual.
Resolves complex complaints and issues relating to Coordination of Benefits health insurance for clients, providers, and insurance companies.
Independently examines correspondence from health insurance carriers and determines appropriate action.
Investigates recipient employment and health insurance benefits using the Automated Client Eligibility System (ACES) & Document Management System (DMS / BARCODE).
Provides expert consultative services relating to coordination of health insurance benefits to clients, providers and other internal and external customers.
Reviews, investigates and responds to inquiries.
Participates in collaborative conversations to share information related to the health insurance unit and the general needs of the Coordination of Benefits and Claims Office.

Benefits

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!

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