Medical Assistance Specialist 4 (MAS4/AHSO) – Internal

State of Washington•Thurston County – Olympia, WA

1d•Remote

About The Position

The Medical Assistance Specialist 4 leads staff in the dental authorization unit, training Medical Assistance Specialist 3s, performing quality control, and updating policies and manuals. The role supports staff with complex situations and may back up the team supervisor when needed. It is a full-time, permanent, remote position, open only to current Health Care Authority employees. Employees must be Washington State residents by their first day of employment and must report to the Olympia office on their first and final days. Occasional in-person meetings, events, or travel may be required based on business needs. The position helps ensure Apple Health dental clients are approved only for procedures, tests, or medications supported by evidence-based guidelines. The role works with providers, colleagues, agency leaders, state and federal partners, and other external partners or customers. Standard business hours are Monday through Friday, 8 a.m. to 5 p.m.; alternative work schedules may be considered based on business needs and supervisor approval.

Requirements

Competency participating in continuous process improvement, including revising prior authorization processes, modifying databases, and developing forms.
Skill consulting with Unit Supervisors and Operations Managers about policy updates, system changes, complex billings, and workload bandwidth.
Ability to clarify intricate program policies, criteria, and provider billing instructions to different healthcare provider types.
Ability to provide high-level consultative services over toll-free lines and handle internal and external communications with a positive, cooperative, professional attitude.
Ability to independently train, onboard, and provide refresher training to staff on systems, initiatives, and program changes.
Competency developing comprehensive training materials with Microsoft Excel, PowerPoint, and Word.
Capability to conduct periodic silent call monitoring and follow up on identified training gaps.
Skill in keeping a team focused, supporting and encouraging peers, and acknowledging team accomplishments.
Ability to ensure accurate and timely responses by delegating and monitoring daily staff workflow.
Ability to independently and professionally handle internal team issues, staff inquiries, and complex customer complaints.
Extensive, current knowledge of Washington Administrative Code guidelines, HCA Provider Guides, and numbered memorandums for legally compliant processing timelines.
Advanced proficiency reviewing and researching complex procedure and diagnosis codes to determine whether authorization requests are complete and valid.
Ability to review and analyze complex billings, claim rejections, denials, credits, and replaced claims to identify root causes and resolve issues.
Expertise verifying client eligibility within the Dental-Related Services package and managing multiple state program requirements.
Technical capability to build authorization screens, track workload inventory, and coordinate complex back-end details such as pricing.
Responsibility for maintaining, updating, and navigating the internal Dental SharePoint repository.
Advanced daily use of Microsoft Word, Excel, Outlook, PowerPoint, Access, RightFax, and custom dental databases.
Competency generating legally compliant, clear, and concise client/provider decision outcome notifications.
Skill working harmoniously with other divisions, systems staff, and external departments.
Required HCA competencies: consider equity in decisions and daily work; take action to learn and grow; and take action to meet others' needs through listening, understanding different perspectives, and responding with care, respect, and solutions.

Nice To Haves

One of the following experience and education combinations: a bachelor’s degree and two years of qualifying experience providing direct client services or customer counseling in a dental office, health insurance, disability or related health benefits, public assistance eligibility determination, health insurance premiums or claims processing, adjusting or investigation, or other medical premiums, claims, or eligibility work, including two years in a dental office with working knowledge of health insurance, claims, or related health benefits.
An associate degree and four years of the described experience.
Six years of the described experience.
One year of experience as a Medical Assistance Specialist 3.

Responsibilities

Independently train and lead staff in determining client eligibility.
Ensure accuracy and timely responses to requests from Medical Assistance Specialist 3 staff.
Review claims related to claim rejections and analyze problems.
Advise providers and generate client notifications of decision outcomes.
Respond to complex staff questions and research answers.
Answer internal and external emails and phone calls from supervisors, systems staff, unit staff, and other departments.
Develop staff training materials using Excel, PowerPoint, and Word.
Train new and existing staff on initiatives and system changes.
Lead Medical Assistance Specialist meetings to discuss process changes and staff questions.
Periodically monitor staff calls silently to assess customer service quality and follow up on training needs.
Participate in continuous process improvement, revising prior authorization processes and procedures, maintaining or modifying databases, and developing forms.
Consult with unit supervisors and operations managers on policy updates, system changes, complex billings, and workload capacity.
Clarify program policies, criteria, and provider billing instructions for healthcare providers.
Delegate and monitor daily staff workflow and keep the team focused and supported.
Handle internal team issues, staff inquiries, and complex customer complaints professionally.
Research procedure and diagnosis codes and assess authorization requests for completeness and validity.
Review complex billings, claim rejections, denials, credits, and replaced claims to identify causes and resolve issues.
Verify client eligibility within the Dental-Related Services package and manage multiple state program requirements.
Build authorization screens, track workload inventory, and coordinate complex back-end details such as pricing with other divisions.
Maintain, update, and navigate the internal Dental SharePoint repository.
Generate clear, concise, legally compliant client and provider decision notifications.
Work collaboratively with other divisions, systems staff, and external departments to streamline multi-program requirements.
Apply an equity lens in decisions, processes, and day-to-day work, and take action to learn, grow, and meet the needs of others.