Provider Enrollment Medical Assistance Specialist 3 (MAS3AHSO) – Nonpermanent

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. Youll work independently answering phone calls and responding to inquiries about enrollment re-enrollment updates and billing this position youll 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 youre 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.

About the division:

Functioning as both the states 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.

About the position:

Working independently in a customer service environment this position enrolls providers into the States Medicaid ProviderOne 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 ProviderOne 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:

1. Ensure only qualified providers are enrolled with HCA and provider eligibility requirements are met for each specialty.

2. Ensure Federal State and other applicable regulations and procedures and policies are followed.

3. 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 accurate decisions.
• Counsel providers on policies and procedures related to enrollment re-enrollment termination and revalidation processes.
• Enters comments and required checklists into ProviderOne for revalidations updates and applications as specified in the manual.
• Independently answers provider inquiries on toll-free lines and responds to correspondence including ServiceNow tickets emails faxes and mail.
• Counsel providers on resolving enrollment-related issues causing billing discrepancies.
• Reviews and verifies provider information for accuracy and completeness to ensure compliance with policies.
• Ensures the manuals procedures and policies are consistently followed during all stages of provider enrollment and revalidation.
• Provides clear and professional communication to address provider concerns and questions effectively.

Required qualifications:

Qualifying candidates will meet one of the following criteria options:

Option 1:

Bachelors degree in a closely related field and one (1) year of the required experience below

Option 2:

Five (5) years of the required experience below

Option 3:

One (1) year as a Medical Assistance Specialist 2.

Note: Experience providing direct client services or counseling of customers in the areas below will substitute year-for-year for the required education.

The required experience includes the following:

• health insurance disability or other related health benefits
• public assistance eligibility determination
• health insurance premiums/claims processing adjusting and investigation
• or other medical premiums/claims related experience

Preferred qualifications:

• Proficient in computer skills including knowledge of the ProviderOne billing system Siebel information storage system and effectively utilize multiple systems and web-based tools simultaneously to complete tasks.
• Knowledge of Medicaidor Apple Health programs.
• Ability to consistently provide excellent customer service during a full shift of continuous phone calls.
• Ability to manage stress arising out of diverse conflicts and the demands of customers to provide the correct resolution of issues within a short period.
• Ability to manage information arising out of conflicting rules and procedures that are established by other sections over which they have no control.
• Ability to counsel and placate customers expectations when they are different from the policy and regulations under WAC.

How to apply:

Only candidates who reflect the required qualifications on their NEOGOV profile will be considered. Failure to follow the application instructions below may lead to disqualification. To apply for this position you will need to complete your profile which includes three professional references and attach:

• A cover letter that specifically addresses how you meet the qualifications for this position
• Current resume

To take advantage of veteran preference please do the following:

• Attach a copy of your DD214 (Member 4 long-form copy) NGB 22 or USDVA signed verification of service letter.
• Please black out any PII (personally identifiable information) data such as social security numbers. Include your name as it appears on your application in .

About HCA:

Functioning as both the states 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 of 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.

What we have to offer:

• Meaningful work with friendly co-workers who care about those we serveVoices of HCA
• A clear agency mission that drives our work and is person-centeredHCAs Mission Vision & Values
• A healthy work/life balance including alternative/flexible schedules and mobile work options.
• A great total compensation and benefit packageWA State Government Benefits
• A safe pleasant workplace in a convenient location with restaurants and shopping nearby.
• And free parking!

Notes:

This position is covered by the Washington Federation of State Employees (WFSE). Once the listed position(s) is(are) filled this recruitment announcement may also be used to fill additional position(s) for up to sixty (60) days.

Prior to a new hire a background check including criminal record history will be conducted. Information from the background check will not necessarily preclude employment.

HCA is an equal opportunity employer. We value the importance of creating an environment in which all employees can feel respected included and empowered to bring unique ideas to the agency. HCA has five employee resource groups (ERGs). ERGs are voluntary employee-led groups whose aim is to foster a diverse inclusive workplace aligned with HCAs mission.Our diversity and inclusion efforts include embracing different cultures backgrounds and viewpoints while fostering growth and advancement in the workplace. Studies have shown women racial and ethnic minorities and persons of disability are less likely to apply for jobs unless they feel they meet every qualification as described in a job description. Persons over 40 years of age disabled and Vietnam era veterans as well as people of all sexual orientations and gender identities are also encouraged to apply. If you have any questions about the required qualifications or how your experience relates to them please contact us at. Persons with disabilities needing assistance in the application process or those needing this job announcement in an alternative format may contact Lisa Fleming at or.

The Washington State Health Care Authority (HCA) is anE-Verify employer. All applicants with alegal right to work in the United States are encouraged to apply.

E-Verify is a registered trademark of the U.S. Department of Homeland Security.

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