Healthcare Eligibility Specialist 3

2 weeks ago

Olympia, Washington, United States State of Washington Full time


Healthcare Eligibility Specialist 3 (MAS3/MCS) - Project

This position may be utilized to fill various roles.

This is a remarkable opportunity to acquire state experience while engaging in meaningful work that aids in providing extensive health coverage to a large population.


Utilize your customer service expertise and contribute to the mission of enhancing health access.



About the Division:


The Division of Medicaid Customer Service (MCS) collaborates across the Health Care Authority (HCA) and with the healthcare community at local, state, and federal levels to develop and manage high-quality, evidence-based healthcare programs that improve access for Medicaid clients.


About the Role:


This Healthcare Eligibility Specialist 3 (MAS3) plays a crucial role in supporting the HCA's mission to ensure medical care access for all eligible citizens.

This role involves determining initial and ongoing eligibility for Medicaid Title XIX, Children's Health Insurance Program (CHIP) Title XXI, and other state-funded medical assistance programs available.

This position allows for telework and typically does not require on-site attendance.

The default assigned work location for all HCA positions is within the State of Washington, with onsite work frequency varying based on operational needs.


Key Responsibilities:

  • Independently assess applications, determine eligibility, and authorize benefits for Medicaid programs managed by the Medical Eligibility Determination Services (MEDS) office.
  • Apply complex federal and state eligibility regulations to specific household situations to ensure accurate eligibility decisions.
  • Utilize and manage multiple interdependent electronic systems, including but not limited to the Automated Client Eligibility System (ACES), HealthPlanFinder, and Microsoft Office.
  • Conduct interviews via telephone, in person, or through written correspondence to gather necessary documentation and verification for program eligibility.
  • Collaborate with individual Take Charge providers to address inquiries and resolve eligibility issues.
  • Respond to inquiries, update eligibility records, and enhance access to medical care for eligible citizens.
  • Work alongside advocates, providers, and other state agencies to clarify information, resolve disputes, and coordinate referrals.

Required Qualifications:
Candidates must meet one of the following criteria:

Option 1:
  • A bachelor's degree AND one (1) year of relevant experience.

Option 2:
  • An associate degree AND three (3) years of relevant experience.

Option 3:
  • A Certificate of Medical Billing and Coding or a closely related program AND three (3) years of relevant experience.

Option 4:
  • Five (5) years of relevant experience.
The required experience includes one or a combination of the following:
  • Providing direct client services or counseling in health insurance or related benefits.
  • Public assistance eligibility determination.
  • Experience in health insurance claims processing or related areas.
  • Researching and analyzing complex regulations and utilizing findings to make determinations while providing customer service.

Preferred Qualifications:
  • Experience in conflict resolution with clients.
  • Knowledge of Medicaid programs and eligibility criteria.
  • Proficiency in Microsoft Office applications.

Application Process:
Only candidates who meet the minimum qualifications will be considered. Please ensure your profile reflects your qualifications.

To apply, complete your profile and attach:
  • A cover letter addressing how you meet the qualifications.
  • A current resume.

About HCA:


The Washington State Health Care Authority (HCA) is a leader in ensuring health access for residents, functioning as both the state's largest healthcare purchaser and behavioral health authority.


HCA oversees Apple Health (Medicaid), the Public Employees Benefits Board (PEBB), and School Employees Benefits Board (SEBB) programs, providing healthcare to millions.


What We Offer:
  • Meaningful work with supportive colleagues.
  • A clear mission that drives our work.
  • A healthy work/life balance with flexible schedules.
  • A comprehensive benefits package.
  • A safe and pleasant workplace environment.
  • Tuition reimbursement opportunities.
  • Free parking.

Notes:
This position is covered by the Washington Federation of State Employees (WFSE). A background check will be conducted prior to hiring. HCA is an equal opportunity employer, committed to creating a diverse and inclusive workplace.

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