Lobby Medical Assistance Specialist 4 (MAS4/AHEA)

State of Washington • Thurston County – Olympia, WA

5d • Onsite

About The Position

The Medical Eligibility Determination Services office in the Health Care Authority’s Apple Health Eligibility and Access Division is hiring a Medical Assistance Specialist 4 to serve as lead worker for a team of eight or more Medical Assistance Specialists. This full-time, permanent position is based in person at the HCA office in Olympia, Washington. The lead provides eligibility expertise on complex Apple Health (Medicaid) and Children’s Health Insurance Program cases, supports staff and daily operations, and acts for the supervisor when needed.

The position applies federal and state eligibility requirements to household circumstances, provides technical guidance, develops and delivers training, reviews work and conducts audits, and improves workflows and procedures. It uses multiple systems, including ACES, ProviderOne, and the Document Management System. The role also researches and represents the agency in administrative hearings and works with advocates, providers, and Community Services Offices to resolve issues.

The successful candidate is a patient teacher and steady leader who works collaboratively in an office setting, communicates clearly, maintains confidentiality, approaches complex cases thoughtfully, and continually looks for ways to improve service and operations. HCA employees must be Washington residents on their first day of employment. The position is scheduled for 40 hours per week, Monday through Friday, with standard business hours of 8 a.m. to 5 p.m.; alternative schedules may be considered based on business needs. Occasional travel may be required.

Requirements

• Demonstrated ability to apply advanced knowledge of federal and state laws, regulations, policies, procedures, and program requirements to complex medical assistance program issues and circumstances.
• Demonstrated skill in analyzing complex, unusual, or escalated program issues, evaluating relevant information and requirements, and developing accurate, well-supported determinations, recommendations, or solutions.
• Demonstrated knowledge of providing technical leadership, guidance, consultation, and expertise to staff and partners regarding complex program requirements, policies, procedures, and work processes.
• Demonstrated proficiency in developing, delivering, or supporting formal training and providing coaching and technical instruction that promotes accurate and uniform application of program rules, policies, procedures, and requirements.
• Demonstrated ability to review and evaluate work for accuracy, quality, and compliance; identify errors, trends, or inconsistencies; and provide guidance or recommendations to improve consistent application of program requirements.
• Demonstrated skill in interpreting complex policies, regulations, and program requirements; evaluating their impact on program operations; and providing technical guidance on appropriate implementation and application.
• Demonstrated proficiency in coordinating and prioritizing work, providing direction and technical assistance to staff, monitoring workflow, and supporting timely completion of program responsibilities.
• Demonstrated ability to communicate complex, sensitive, or technical program information and provide effective consultation to staff, management, providers, customers, and other partners.
• Ability to consider equity in decisions, processes, and day-to-day work, including effects on people and communities served.
• Ability to learn and grow by seeking new perspectives, learning from experience, and using learning to improve work and service.
• Ability to meet others’ needs by listening, understanding different perspectives, and responding with care, respect, and solutions.
• Must be a Washington state resident on the first day of employment.
• Submit a cover letter, resume, and three professional references, including at least one current or recent supervisor.

Nice To Haves

• Experience as a Medical Assistance Specialist 3.
• Professional experience providing direct client services or customer counseling related to health insurance, disability or other health benefits; public assistance eligibility determination; health insurance premiums or claims processing, adjusting, or investigation; or other medical premiums or claims work.
• Experience with ACES, Washington Healthplanfinder, MVP, ProviderOne, and/or Barcode/DMS.

Responsibilities

• Serve in person as lead for a team of eight or more Medical Assistance Specialists and monitor workload and priorities.
• Act on behalf of the supervisor during absences and support day-to-day team operations.
• Provide eligibility support and clarification to staff, interpret policy and regulations, and help determine final dispositions of complex eligibility cases.
• Apply complex federal and state eligibility rules, including WAC and RCW, to make accurate initial and ongoing eligibility decisions.
• Develop and deliver training on eligibility, systems, interviewing, and workload management for new and experienced staff, including training on program changes and performance gaps.
• Conduct internal program audits to identify error trends and performance issues.
• Analyze workflow and system problems and devise and implement new or revised procedures.
• Use interconnected systems, including ACES, ProviderOne, and the Document Management System (DMS).
• Research, prepare, and represent the agency in administrative hearings.
• Partner with advocates, providers, and Community Services Offices to resolve issues.

Benefits

• Medical, dental, vision, and basic life insurance.
• Paid vacation, sick leave, and 12 paid holidays.
• Paid Family and Medical Leave (PFML).
• Retirement options.
• Training and professional development opportunities.
• Employee wellness programs.
• Remote work and flexible schedules are listed as benefits available to HCA employees generally; this specific position is in person.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: No Education Listed