Medical Assistance Specialist ; MAS​/AHSO

Medical Assistance Specialist 3 (MAS3/AHSO)

This recruitment will be used to fill multiple positions.

These positions determine individual and family eligibility for Washington State medical assistance programs. Within the Apple Health Services and Operations (AHSO) Division, this position supports the Health Care Authority (HCA) mission to provide access to medical care for all eligible Washington citizens.

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 Apple Health Services and Operations (AHSO) Division works across the Health Care Authority (HCA) and in partnership with the health care community at local, state and federal levels, in order to develop, and manage high quality, and evidence-based health care programs and purchase services that enhance Washington State’s citizens’ ability to access appropriate, quality health care.

This position supports the HCA mission to provide access to medical care for all eligible Washington citizens. The position determines initial eligibility and/or ongoing individual and family medical eligibility for Medicaid Title XIX, Children’s Health Insurance Program (CHIP) Title XXI program, 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. 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. All agency employees are required to report on‑site in Olympia on their first and last days of employment to pick up and return state‑issued equipment, regardless of telework status or location.

• 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 Automated Client Eligibility System (ACES), Health Plan Finder , Provider One, Audit Plus, Microsoft Office, SOLQ, Document Management System (DMS), 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 Take Charge providers to answer inquiries and resolve issues related to eligibility for the Take Charge Family Planning program.
• Answer inquiries, resolve questions, update eligibility records and otherwise maintain and expand access to medical care for eligible Washington citizens.

Qualifying candidates will meet one of the following criteria options:

• Bachelor’s degree and
• One year of qualifying experience as defined below.

• Associate degree and
• Three years of qualifying experience as defined below.

• Completion of a Certificate of Medical Billing and Coding, or closely related certificate program and
• Three years of qualifying experience as defined below.

• Five years of qualifying experience as defined below.

• One year as a Medical Assistance Specialist 2.

• Providing direct client services or counseling of customers in the areas of health insurance, disability, or other related health benefits;
• public assistance eligibility determination;
• hea…