COBCO Health Insurance Specialist (MAS3AHSO)

COBCO Health Insurance Specialist (MAS3/AHSO)

This recruitment may be used to fill multiple positions.

This position investigates and researches cases of Medicaid billing to determine whether third party liability coverage should have been used. The goal of this work is to ensure that Medicaid has been the payer of last resort to ensure proper use of these public funds. This work requires delving into situations to find new information and wade through ambiguity with a goal of ensuring medical costs being covered by the correct entities. If you are a problem solver who likes to ask questions and dig deep to uncover issues or explore curiosities this may be the position 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:

The organizations mission is to provide high quality health care through innovative health policies and purchasing strategies. 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 States citizens ability to access appropriate quality health care.

About the position:

This position resides in the Health Insurance Unit (HIU) within the Coordination of Benefits and Claims Office (COBCO) and supports HCAs vision for a healthier Washington via both health purchasing strategies as well as customer-centered service. This position investigates and verifies potential third party liability (TPL) coverage leads and integrates third party liability coverage into the ProviderOne MMIS to ensure cost avoidance or cost recovery of Medicaid expenditures assuring Medicaid will be the payer of last resort. TPL refers to the legal obligation of third-party health care sources to pay for a claim for a Medicaid client before Medicaid pays the this position staff independently provide expert consultative services to providers and clients both orally and in writing concerning coordination of TPL and Medicaid benefits.

Some of what you will do:

• Makes complex judgments and payment determinations in accordance with state and federal law and regulations and HCA policy.
• Investigates and analyzes insurance documents reports files and other resources to determine private health insurance benefits and eligibility.
• Accesses ProviderOne subsystems and updates and maintains control files used to adjudicate claims and determine Managed Care enrollment eligibility.
• Recovers funds from insurers when a private health insurer is liable for costs incurred by a Medicaid eligible individual.
• Resolves complex complaints and issues relating to Coordination of Benefits health insurance for clients providers and insurance companies.
• Independently examines correspondence from health insurance carriers and determines appropriate action.
• Investigates recipient employment and health insurance benefits using the Automated Client Eligibility System (ACES) & Document Management System (DMS / BARCODE).
• Provides expert consultative services relating to coordination of health insurance benefits to clients providers and other internal and external customers.
• Reviews investigates and responds to inquiries.
• Participates in collaborative conversations to share information related to the health insurance unit and the general needs of the Coordination of Benefits and Claims Office.

Required qualifications:

Qualifying candidates will meet one of the following criteria options:

Option 1:

• Bachelors degree and
• One year of the experience defined below.

Option 2:

• Associate degree and
• Three years of the experience defined below.

Option 3:

• Certificate of Medical Billing and Coding or a closely related certificate program and
• Three years of the experience defined below.

Option 4:

• Five years of the experience defined below.

Option 5:

• One year as a Medical Assistance Specialist 2.

Qualifying experience is defined as:

• providing direct client services or counseling of customers in the areas of health insurance disability or other related health benefits;
• public assistance eligibility determination;
• health insurance premiums/claims processing adjusting and investigation;
• other medical premiums/claims/eligibility related experience; or
• experience researching and analyzing complex rules regulations or policies and utilizing research and analysis to make determinations solve problems or complete work while providing direct customer service either in person or on the telephone.

Required competencies:

• The ability to take action to learn and grow.
• The ability to take action to meet the needs of others.

Preferred qualifications:

Demonstrated experience with:

• Communicating with external parties to acquire or understand complex information
• Navigating web sites and online resources to perform research and make decisions
• Writing correspondence on complex topics in a way that makes concepts clear to the recipient
• Navigating complex problems for which there may be incomplete information or context
• Microsoft products (Outlook OneNote Excel Teams Word etc)
• Strong oral and written communication skills while providing excellent customer service
• Resolving complex complaints problems and conflicts with clients providers and insurance companies
• Critical thinking skills; use good judgment in evaluating situations and making decisions
• Private commercial insurance coverage benefits and eligibility
• Independently performing a wide range of technical duties with limited supervisory direction
• ProviderOne Barcode Service Now (SNOW) and ACES Online
• Commitment to collaboration clear communication and shared success

Knowledge of:

• Private commercial insurance coverage and eligibility verification
• Medical terminology procedure and diagnosis codes and pharmacy billing
• Medical billing and insurance claim processes and claims adjudication
• Medical terminology procedure and diagnosis codes pharmaceutical usage
• Medicaid programs and eligibility

Demonstrated ability to:

• Analyze medical and dental coverage details and make appropriate determinations
• Understand and apply procedures policies and guidelines
• Learn new and/or increasingly complex tasks
• Work effective together with a commitment to collaboration clear communication and shared success

How to apply:

Only candidates who reflect the minimum 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 in separate files:

• 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 serve Voices of HCA
• A clear agency mission that drives our work and is person-centered HCAs Mission Vision & Values
• A healthy work/life balance including alternative/flexible schedules and mobile work options.
• A great total compensation and benefit package WA 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 Jake Nelko at or 360.725.0945.

The Washington State Health Care Authority (HCA) is an E-Verify employer. All applicants with a legal 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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