Provider Enrollment Medical Assistance Specialist ; MAS​/AHSO – Nonpermanent

Description

Provider Enrollment Medical Assistance Specialist 3 (MAS3/AHSO) – Nonpermanent

This recruitment will be used to fill multiple positions. This is a non-permanent position ending 3/31/27.

Make a difference in health care with a role that offers telework flexibility and the opportunity to support providers and customers. You’ll work independently, answering phone calls and responding to inquiries about enrollment, re-enrollment, updates, and billing issues. In this position, you’ll analyze complex situations, find solutions, and ensure compliance with Affordable Care Act rules. Your tasks will include conducting database checks, revalidations, collecting fees and disclosures, coordinating site visits, and assisting with background checks.

If you’re a problem-solver who thrives in a fast-paced environment and values flexibility, this role is for you! All HCA employees will apply an equity lens to their work, which may include but is not limited to all analyses of core business and processes.

Functioning as both the state’s largest health care purchaser and its behavioral health authority, the Washington State Health Care Authority (HCA) is a leader in ensuring Washington residents have the opportunity to be as healthy as possible. There are three pillars to our work:
Apple Health (Medicaid); the Public Employees Benefits Board (PEBB) and School Employees Benefits Board (SEBB) programs; and behavioral health and recovery. Under these pillars, HCA purchases health care, including behavioral health treatment for more than 2.7 million Washington residents and provides behavioral health prevention, crisis, and recovery supports to all Washington residents.

Working independently in a customer service environment, this position enrolls providers into the State’s Medicaid Provider One System to allow providers to bill for services and items for Medicaid clients. This position also revalidates and reviews updates from enrolled providers to ensure providers continue to meet eligibility requirements and are in good standing. This position uses a knowledge of the provider subsystem of Provider One, the Core Provider Agreement, and associated documents, processes and policies to support the mission of Provider Enrollment within the Health Care Authority by working to:

• Ensure only qualified providers are enrolled with HCA and provider eligibility requirements are met for each specialty.
• Ensure Federal, State and other applicable regulations and procedures and policies are followed.
• Ensure applications and related work are approved in a timely manner.

This position is eligible to telework and is typically not required to report on-site. The default assigned work location of all Health Care Authority (HCA) positions – both on-site and telework eligible positions – is within the State of Washington. This position reports to Olympia, WA. Frequency of onsite work will vary based on business and operational needs. HCA has currently suspended the ability to support out-of-state telework.

Some of what you will do:

• Work independently to determine provider eligibility for medical assistance programs by validating providers meet requirements for specialties, licensure, certifications, and other applicable requirements.
• Independently approves provider revalidations, updates, and applications for enrollment, ensuring only qualified providers in good standing are approved.
• Implements policies and ensures compliance with regulations when approving revalidations, updates, and applications.
• Conducts thorough reviews for completeness, ensuring all required fields, including disclosure requirements, are filled out by providers.
• Verifies critical documents, such as the Core Provider Agreement, W-9, Disclosure Form, Debarment Form, and EFT, ensuring all required signatures are present.
• Performs database checks on providers, ownership, managing employees, and controlling interests using tools like the Automated Provider Screening tool and primary source databases (e.g., IRS, DOH, OIG, SAM, PECOS).
• Analyzes records, cases, and situations to determine necessary actions and make timely,…