Medical Assistance Specialist 3 – Federal Way (MAS3/AHEA)

State of Washington • King County - Federal Way, WA

9d • Hybrid

About The Position

The Medical Assistance Specialist 3 works in the Medical Eligibility Determination Services (MEDS) office of the Health Care Authority’s Apple Health Eligibility and Access Division. Based at Federal Way Public Health in Federal Way, Washington, this permanent, full-time hybrid role determines eligibility for Apple Health (Medicaid), the Children’s Health Insurance Program (CHIP), and other state-funded medical assistance programs. The position applies federal and state eligibility rules to each household’s circumstances and includes onsite client interviews and phone-based customer service. The hybrid schedule generally includes three to four onsite days per week.

The specialist independently assesses initial and ongoing eligibility, researches complex cases, makes determinations, and authorizes benefits. The role uses interconnected eligibility and records systems and involves gathering documentation, assisting clients and partners, resolving disputes, coordinating referrals, and contributing to process improvements. The position regularly works with clients, providers, advocates, state agencies, the Health Benefit Exchange, and community organizations.

The successful candidate is patient, detail-oriented, self-directed, organized under competing demands, tactful in challenging interactions, and committed to continued learning and improving service. HCA employees are expected to consider equity in their decisions and daily work and to respond to community needs with care and respect.

The position is covered by the Washington Federation of State Employees (WFSE). The duty station is Federal Way Public Health; employees must also report to the Olympia office on their first and final employment days. Occasional travel may be required for meetings, training, or other business needs. All HCA employees must be Washington State residents on their first day of employment.

Requirements

• Demonstrated ability to interpret and apply regulations, policies, and procedures.
• Demonstrated ability to independently research, analyze, and evaluate complex information to make accurate determinations and resolve program-related issues within established authority.
• Demonstrated ability to identify, analyze, and resolve complex issues.
• Demonstrated ability to research and interpret complex program rules, regulations, policies, procedures, and authoritative information and apply findings appropriately to individual circumstances.
• Demonstrated ability to provide accurate technical information, consultation, and assistance to customers, providers, members, and other partners regarding complex issues and requirements, using effective de-escalation strategies.
• Demonstrated ability to communicate complex or technical information clearly, accurately, and professionally, verbally and in writing, to people with varying levels of program knowledge.
• Demonstrated ability to independently produce accurate, complete, and timely work while ensuring compliance with applicable laws, regulations, policies, procedures, and program standards.
• Demonstrated ability to independently organize and prioritize complex assignments, manage competing demands, meet established timelines, and exercise sound judgment with limited supervisory direction.
• Patient, steady, and genuinely interested in helping people, including during difficult conversations.
• Ability to handle challenging interactions with tact and diplomacy and build positive working relationships with clients, advocates, and coworkers.
• Detail-oriented, self-directed, organized, eager to learn, and interested in improving processes.
• Consider equity in decisions, processes, and daily work; seek new perspectives and learning; and listen and respond to others with care and respect.
• Washington State residency on the first day of employment.
• Submit a completed online application, a cover letter describing qualifications for the position, a resume detailing applicable experience and education, and three professional references entered in the application, including at least one current or recent supervisor.

Nice To Haves

• Associate or bachelor’s degree.
• Professional experience providing direct client services or customer counseling in health insurance, disability, related health benefits, public assistance eligibility determination, health insurance premiums or claims processing, adjusting or investigation, other medical premiums, claims or eligibility, or researching complex rules, regulations, or policies and applying findings to determinations or problem-solving while providing direct customer service in person or by telephone.
• Experience as a Medical Assistance Specialist 2.
• Ability to resolve customer conflicts professionally and effectively while maintaining positive working relationships.
• Knowledge of Medicaid programs and eligibility requirements and ability to apply that knowledge in assigned work.
• Ability to use Microsoft Office applications, including Outlook, Word, and SharePoint, to support business operations and communication.

Responsibilities

• Independently determine initial and ongoing eligibility for Medicaid Title XIX, CHIP Title XXI, and other Medicaid and state-funded medical assistance programs administered by MEDS.
• Apply complex federal and state eligibility rules, including WAC and RCW requirements, to household circumstances; make accurate eligibility decisions and authorize benefits.
• Research and resolve complex eligibility issues with a high degree of independence.
• Use the Automated Client Eligibility System (ACES), Washington Healthplanfinder, ProviderOne, and the Document Management System (DMS).
• Conduct onsite client interviews at Federal Way Public Health and communicate with clients, providers, and third parties by phone and in writing to obtain required documentation and verification.
• Answer inquiries, update eligibility records, and help maintain and expand access to free and low-cost medical care for eligible Washington residents.
• Partner with advocates, providers, the Health Benefit Exchange, other state agencies, and community-based organizations to answer questions, resolve disputes, and coordinate referrals.
• Participate in process-improvement efforts to streamline MEDS operations.
• Organize and prioritize complex assignments, manage competing demands, meet timelines, and exercise sound judgment with limited supervisory direction.
• Consider equity in decisions, processes, and day-to-day work; continue learning and respond to others with care, respect, and practical solutions.

Benefits

• Comprehensive benefits package supporting health, financial well-being, and work-life balance.
• 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.

What This Job Offers

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