Remote Medicaid Benefits Specialist

Health Benefits Specialist 3

This is a remote position that is typically not required to report on-site.

This recruitment may be used to fill multiple positions.

This position works in a customer service and call center environment to explain medical benefit scope of care, enroll Washington Apple Health (Medicaid) clients into managed care plans, resolve procedural problems involving clients, insurance carriers, or providers, and research to resolve complex inquiries regarding claims, problems, and conflicts in the Medical Assistance Customer Service Center (MACSC). If you enjoy providing excellent customer service via phone, learn quickly, and demonstrate strong problem-solving skills, this may be the position for you.

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:

• Provides expert consultation to clients, providers, Managed Care Organizations (MCO), local community service offices (CSO), and stakeholders regarding benefits and services provided by the Apple Health (Medicaid) program, and other state programs in a call center environment and in writing.

• Counsels and advises customers on Health Care Authority (HCA) policies, scope of care, clients’ rights and responsibility, and Medical Assistance policy, procedure, and health benefits.
• Tactfully manages difficult situations and provides quality customer service.
• Coordinates service referral, eligibility information, and managed care membership information between managed care plan, local CSOs, other state agencies, community service organizations, and medical and social services providers.
• Assists customers in resolving disputes and other issues related to their benefit service package or managed care plan.
• Resolves complex questions, claims issues, complaints, and problems about eligibility, accessibility to services, enrollment, and other insurance coverage.
• Assists customers in determining managed care eligibility, selecting and enrolling in or changing managed care plans, and resolving issues regarding health care choices and access to medical services.
• Analyzes, evaluates, and assists with claims submission for medical and social service providers.
• Maintains a thorough knowledge of Provider One (P1), Point-Of-Sale pharmacy claims processing system (POS), Automated Client Eligibility System (ACES), Treasury Management System (TMS), Siebel Contact Management System and Siebel and Avaya soft phone, State and Federal Title XIX policy, managed care programs, Health Plan finder application (Health Benefit Exchange System), and medical terminology.

Required qualifications:

• Medical Assistance Program Knowledge:
  Demonstrated ability to interpret and apply applicable federal and state laws, regulations, policies, procedures, and program requirements related to medical assistance programs, benefits, eligibility, enrollment, services, or claims.
• Independent Analysis and Determination:
  Demonstrated ability to independently research, analyze, and evaluate complex information to make accurate determinations and resolve program-related issues within established authority.
• Customer and Stakeholder Consultation:
  Demonstrated ability to provide accurate technical information, consultation, and assistance to customers, providers, members, partners, and other stakeholders regarding medical assistance programs and requirements.
• Professional Communication:
  Dem…