Medical Assistance Specialist ; MAS​/MEDS

Medical Assistance Specialist 3 (MAS3/MEDS)

The Medical Assistance Specialist 3 (MAS3) helps ensure that Washington residents get the coverage they need by determining eligibility for Medicaid, CHIP, and other medical assistance programs. This role will apply federal and state rules, use multiple eligibility systems, and work directly with individuals, families, providers, and teammates to resolve complex cases with care and accuracy. This position is primarily remote for Washington State residents, with minimal travel and occasional on‑site work as needed.

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.

The Health Care Authority (HCA) of Washington State administers programs that provide health care insurance coverage to over 2 million Washington residents and 400,000 public employees, their dependents, and retirees. HCA promotes health care access to the uninsured, underinsured and Tribes and has an annual budget of approximately $8 billion. This position is responsible for supporting the Medical Eligibility Determination Section (MEDS) within the Apple Health Services and Operations Division at the Health Care Authority.

The Medical Assistance Specialist 3 supports the HCA mission to provide access to medical care for all eligible Washington citizens. This position determines initial eligibility and/or ongoing individual and family medical eligibility for Medicaid Title XIX, Children’s Health Insurance Program (CHIP) Title XXI, and other Medicaid and state‑funded medical assistance programs available in Washington State.

This position is eligible to telework and is typically not required to report on‑site. Minimal travel may be required to attend training, conferences, or events. The default assigned work location of all Health Care Authority 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.

• Independently determine initial and/or ongoing eligibility for Health Care Authority Medicaid Title XIX, CHIP Title XXI, and other Medicaid and state‑funded medical assistance programs administered by the MEDS office.
• Apply complex federal and state eligibility regulations published in WAC and RCW to specific household circumstances resulting in accurate eligibility decisions.
• Use and manage multiple interdependent electronic systems including but not limited to the Automated Client Eligibility System (ACES), Health Plan Finder , Provider One, Microsoft Office, SOLQ, and Employment Security Department (ESD).
• Analyze, research and resolve complex eligibility issues applying proper rules and procedures with a high degree of independence.
• Conduct interviews over the telephone, in person, and/or through written correspondence with clients, providers and/or third parties to obtain information for required documentation and verification to support program eligibility. Establish effective working relationships with clients and their advocates and manage difficult interactions with tact and diplomacy.
• Work with individual Family Planning providers to answer inquiries and resolve issues related to eligibility for the Family Planning program.
• Work in partnership with advocates, providers, Health Benefit Exchange, other state agencies, community‑based organizations and other units within HCA to provide clarification, resolve disputes, solve problems, coordinate referrals and/or answer inquiries.
• Using excellent written and oral communication skills, apply effective customer service techniques and principles to all interactions with customers, their advocates, and other stakeholders. Maintain current and thorough knowledge of rules of eligibility for Medicaid programs, managed care and other areas in the Health Care Authority to provide comprehensive responses to questions or concerns from the public and our customers.
• Take part in training…