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Medical Assistance Specialist 3 (MACSC)
OLYMPIA WA 98507
Category: Other
  • Your pay will be discussed at your interview

Job code: lhw-e0-89771791

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Washington State

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Summary

  Job posted:   Thu May 17, 2018
  Distance to work:   ? miles
       
  1 Views, 0 Applications  
 
Medical Assistance Specialist 3 (MACSC)
Description
*This job posting is being used to fill multiple positions, and will remain open until filled. Screening of application materials will begin immediately and will be on-going. It is in the applicants' best interest to submit their application materials as early as possible. The hiring manager reserves the right to make a hiring decision at any time. This job posting may be closed at any time without notice.*
In a customer service and call center environment provides consultative services to clients, providers, and other external customers. Explains scope of care in regards to medical benefits, enrolls Washington Apple Health (Medicaid) clients into managed care plans. Resolves procedural problems involving clients, insurance carriers or providers, researches and resolves complex inquiries regarding claims, problems, and conflicts. This supports the mission of providing quality services that enhance our clients' ability to obtain and access health care.
This section is responsible for providing timely and accurate adjudication of claims for providers who provide services to Medicaid clients.
**Some duties of this position: **
* Within Medicaid Eligibility Community Support (MECS), independently reviews cases and situations to make timely and accurate decisions. Provides expert consultation to clients, providers, Managed Care Organizations (MCO), local community service offices (CSO), and stake holders regarding benefits and services provided by the Apple Health (Medicaid) program, and other state programs via toll-free lines and written correspondence.
* Counsels callers on changes in policy, billing guides and P1 text files. Promote knowledge of policy and laws in assisting providers with their claims submission, payment and provides self-service resources.
* Assist clients with issues concerning eligibility, policy, billing complaints, transportation, access to care, and manage care plans enrollments, exemptions and disenrollment's.
**Some of the tasks this position will perform:**
* Counsels effectively and advises all customers on Health Care Authority (HCA) policies, scope of care, clients' rights and responsibility and Medical Assistance policy, procedure and health benefits as outlined in RCW and WAC. Tactfully handle difficult individuals and provides quality customer services.
* Analyzes, negotiates and resolves complex client and provider issues or technical problems with a high degree of independence.
* Coordinates service referral, eligibility information and managed care membership information between managed care plan, local community services offices, other state agencies, community service organizations, medical and social services providers. Assists customers in resolving disputes and other issues related to their Benefit Service Package or Managed Care Plan, reissues Services Card and provides self-service resources.
* Resolves complex questions, claims issues, complaints and problems about eligibility, accessibility to services, enrollment and other insurance coverage. Uses information, questions and complaints from clients and client advocates to enhance program policy and procedures.
* Assists customers in determining managed care eligibility, selecting and enrolling in or changing managed care plans and resolving issues regarding client health care choices and access to medical services.
* Analyzes, evaluates and assists with claims submission for medical and social service providers for correct adjudication and provider payment.
* Provides information regarding programs and services responding to customers via USPS mail and ContactUs email.
* Researches and identifies workflow and system problems, implements new and revised procedures and reports ongoing system operations. Deals with the broader aspect of Provider One Payment System (P1) activities as well as individual claims and provider activities.
**About the HCA:**
HCA administers health benefits for Medicaid enrollees, including those eligible under the Affordable Care Act, and public employees' eligible under the Public Employees Benefit Board (PEBB) programs. The agency controls operating funds totaling $20 billion each biennium and it employs approximately 1,179 staff. As the single state agency for Medicaid, HCA administers Washington's Medicaid program which provides federal and state medical assistance to over 1.9 million of Washington's most vulnerable, low-income individuals. HCA promotes health care access to the uninsured, underinsured, and Tribes.
The Olympia office is located in downtown Olympia, within walking distance of shops, restaurants, bus lines, and less than one mile from the freeway.
**Required Education, Experience, and Competencies.**
A Bachelor's degree
OR
Three years of experience performing the following duties:
researching and analyzing complex rules, regulations, or policies
utilizing research and analysis to make determinations, solve problems, or complete work
providing direct customer service either in person or via the telephone
Candidates must have three years' experience performing each of the duties, but experience may be gained concurrently.
**Preferred/Desired Education, Experience, and Competencies.**
* Experience performing conflict resolution with customers
* Knowledge of Medicaid programs and eligibility
* Experience utilizing Microsoft Office programs such as Outlook, Word, and SharePoint
**How to Apply:**
Only candidates who reflect the minimum qualifications on their State application will be considered. Failure to follow the application instructions below may lead to disqualification. To apply for this position you will need to complete your profile and attach:
* A cover letter
* Current resume
* Three professional references
**_Ple__ase Note the Following:_**
*This position is covered by the Washington Federation of State Employees (WFSE). As a condition of employment, candidates who are appointed are required to either become members of the Union and pay membership dues or, as non-members pay a non-association or a representation fee.*
*If you have questions about the process, or need reasonable accommodation, please contact the recruiter before the posting closes. The candidate pool certified for this recruitment may be used to fill future similar vacancies for up to the next six months***_._**
*Washington State is an equal opportunity employer. Persons with disabilities needing assistance in the application process, or those needing this job announcement in an alternative format may call the Human Resources Office at 360.725.0945 or email*_Sidra.Fields@hca.wa.gov_
**_*_ _Prior to a new hire, a background check including criminal record history will be conducted. Information from the background check will not necessarily preclude employment but will be considered in determining the applicant's suitability and competence to perform in the position. *_**
*Salary:* $2,984.00 - $3,883.00 Monthly
*Location:* Thurston County - Olympia, WA
*Job Type:* Full Time - Permanent
*Department:* Health Care Authority
*Job Number:* 2018-04923
*Closing:* Continuous
*Agency:* State of Washington
*Address:* View Job Posting for Agency Information View Job Posting for Location, Washington, 98504
*Phone:* View Posting for Agency Contact
*Website:*

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