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 a team of medical assistance specialists handling pharmacy authorizations. The role supports staff with complex questions, performs quality reviews, provides training on processes and procedures, and works with other departments, including clinical and Apple Health staff. This is a full-time, permanent, remote position open only to current HCA employees. Employees must be Washington state residents on their first day of employment and must report to the Olympia office on their first and final days. Occasional in-person meetings, events, or other travel may be required based on business needs. The position works in the Apple Health Services and Operations division, which develops and manages evidence-based health care programs in partnership with HCA and the health care community. The role regularly collaborates with colleagues, agency leaders, state and federal partners, and external partners or customers. The standard schedule is 40 hours per week, Monday through Friday, 8 a.m. to 5 p.m.; alternative schedules may be considered based on business needs and supervisor approval. Applicants must complete the online application and provide a cover letter describing their qualifications, a resume detailing applicable experience and education, and three professional references entered in the application, including at least one current or recent supervisor.

Requirements

Demonstrated knowledge of federal and state laws, regulations, policies, procedures, and program requirements applicable to complex medical assistance program issues and circumstances.
Demonstrated proficiency analyzing complex, unusual, or escalated program issues, evaluating relevant information and requirements, and developing accurate, well-supported determinations, recommendations, or solutions.
Demonstrated expertise providing technical leadership, guidance, consultation, and support to staff and stakeholders regarding complex program requirements, policies, procedures, and work processes.
Demonstrated ability to develop, deliver, or support formal training and provide coaching and technical instruction that promotes accurate and uniform application of program rules, policies, procedures, and requirements.
Demonstrated proficiency reviewing and evaluating work for accuracy, quality, and compliance; identifying errors, trends, or inconsistencies; and recommending improvements.
Demonstrated knowledge of interpreting complex policies, regulations, and program requirements, evaluating their impact on operations, and communicating guidance to staff and stakeholders.
Expertise reviewing and understanding WACs and how they relate to the unit’s work.
Ability to navigate and balance a high volume and variety of work.
Consider equity in decisions, processes, and day-to-day work, including effects on the people and communities served.
Ability to learn and grow by seeking new perspectives, learning from experience, and continuously improving work and service.
Ability to meet the needs of others by listening, understanding different perspectives, and responding with care, respect, and appropriate solutions.
Current HCA employee; all HCA employees must be Washington state residents upon their first day of employment.
Complete the online application and submit a cover letter, resume, and three professional references, including at least one current or recent supervisor.

Nice To Haves

Six years of a combination of experience and/or higher education; a bachelor’s degree counts as four years and an associate degree counts as two years.
Experience providing direct client services or counseling in health insurance, disability, or related health benefits; public assistance eligibility determination; health insurance premiums or claims processing, adjusting, and investigation; or other medical premiums or claims-related work.
Demonstrated knowledge of health care organizations, delivery systems, and processes supporting access to quality health care services.
Demonstrated understanding of Medicaid, state-managed care programs, and factors affecting client access to quality health care services.
Demonstrated knowledge of client complaint and grievance procedures, including processes for addressing concerns and resolving service-related issues.
Demonstrated ability to educate clients, providers, and staff about Medicaid prior authorization requirements, procedures, and processes for obtaining covered health care services.
Demonstrated ability to communicate clearly and effectively with individuals and groups, adapting communication styles for diverse audiences and organizational needs.
Demonstrated ability to train, guide, and lead staff while modeling respectful behavior, encouraging collaboration, and promoting open, constructive communication.

Responsibilities

Perform quality control within the Pharmacy Authorization Unit to ensure adherence to protocols and guidelines.
Train MAS3 staff to case manage pharmaceutical requests.
Assist the supervisor and MAS3s in identifying, reviewing, and making final decisions on complex pharmacy authorization requests.
Consult with management on pharmacy policies and procedures, problem solving, workflows, and public relations.
Respond to online inquiries about pharmacy authorizations, policies, and procedures.
Use Provider One, CRM, FlexRx, Right Fax, and Drug Rolodex to process a high volume of authorizations accurately.
Monitor providers identified as deviating from Pharmacy Program Section standards for compliance.
Coach staff, manage the team’s SharePoint, and meet with staff across the division.
Collaborate regularly with colleagues, agency leaders, state and federal partners, and external partners or customers.