Medical Assistance Specialist 4 (MAS4FS) – Internal only

Thurston County, WA - USA

Yearly Salary: $ 51840 - 69744

Posted on: Yesterday

Vacancies: 1 Vacancy

Job Summary

Description

Medical Assistance Specialist 4 (MAS4/FS) Internal only

This opportunity is internal and available to current HCA employees only.

For individuals who enjoy mastering complex systems and regulations this role offers a chance to develop deep expertise in the Medicaid Drug Rebate program a niche but critical area of pharmacy and medical claim evaluation and processing. This position helps ensure the integrity and efficiency of a vital government healthcare program. The work generates substantial revenue which directly contributes to cost offsets for the states Medicaid program freeing up funds for other essential services. Ensuring federal compliance means the program continues to receive necessary federal funding and support. If you want to make a real difference in your community then this is the role 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:

This position is located within the Health Care Authorities (HCA) Financial Services Division (FSD) which in collaboration with other HCA divisions and a variety of external stakeholders and legislative partners provides strategic financial expertise for Apple Health PEBB and SEBB addition FSD oversees the budget and compliance functions necessary to manage and monitor the single largest Washington State individual agency operating budget. Functions include budget management accounting forecasting professional and hospital rate setting financial analysis and payment/collection operations. This division maintains a close working relationship with agency program policy and clinical divisions to ensure financially sound implementation and monitoring of program strategies. It is also accountable to the Governor and legislature in ensuring HCA operates within its budget.

About the position:
This Medical Assistance Specialist 4 position within the Medicaid Drug Rebate Program (MDRP) is located in the Financial Services Division Hospital Finance and Drug Rebate unit. The Invoicing Analyst is responsible for ensuring that Medicaid fee-for-service managed care and supplemental drug rebates (approximately $200 million/quarter) are invoiced accurately timely and within federal guidelines. This position contributes to the overall mission of HCA in that these drug rebates offset Medicaid program expenditures.

This position is eligible to telework but is required to report on-site for mandatory meetings approximately 4-6 times a year. 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.

Duties

Some of what you will do:

As the expert in the Drug Rebate Invoicing Program utilize Pharmacy Point of Sale (POS) ProviderOne (P1) and Drug Rebate systems to independently research and analyze paid claims submitted by pharmacy and medical providers; perform quality assurance by verifying claim accuracy/appropriateness; perform claim corrections/adjustments as necessary to ensure successful completion of the critical drug rebate invoicing process.
Identify analyze and correct provider claims with common pharmacy quantity errors and P1conversion errors.
Use expertise and knowledge of drug rebate systems to continually monitor and analyze the automations workflow and processes affecting drug rebate for errors or other issues.
Use expert-level knowledge of critical drug rebate invoicing processes and complex regulations to independently interpret and apply federal program requirements policies procedures and guidelines.
Communicate with external providers and educate them regarding claim outliers; train providers regarding billing guidelines and requirements to facilitate accurate invoicing and pre-empt disputes.
Manage the agencys invoicing email box; respond to more complex invoice questions as well as general inquiries from participating drug manufacturers; direct stakeholders to drug rebate invoicing regulations and educate them regarding federal guidelines when necessary.
Receive data files from CMS for loading into the drug rebate invoicing system store and document receipt of files.
Review and store output reports perform updates to invoicing information and take any other actions necessary as a result of report review.

Qualifications

Required qualifications:

Qualifying candidates will meet one of the following criteria options:

Option 1:

A bachelors degree in a related field including Business Administration Health Care Policy or a related field.
Two (2) years of experience providing direct customer services or counseling of internal/external stakeholder; facilitate stakeholder and/or staff training and developmenteither in person or in a virtual environment; implementing developing/maintaining desk manuals in the areas of systems workflow and advising on process improvement; educating/advising providers on program requirements existing policies and best practices; providing guidance on claims processing adjusting and analysis; or other medical premiums/claims related experience.

Option 2:

Six years of experience as listed above.

Option 3:

One year as a Medical Assistance Specialist 3

Required competencies:

The ability to take action to learn and grow.
The ability to take action to meet the needs of others.
Skilled in customer service with a willingness to take initiative.
Must be able to provide customer service via telephone calls virtual meetings using platforms like Microsoft Teams or Zoom and in-person as required to communicate findings to stakeholders to include providers drug manufacturers managed care organizations and/or HCA staff.
Proficient in Excel and knowledge of other Microsoft Office programs.
Ability to manage competing priorities in an office or virtual work environment including the ability to prioritize and complete work within mandated deadlines.

Preferred qualifications:

Knowledge of how to navigate in ProviderOne Point of Sale and Drug Rebate Invoicing systems.
Ability to utilize available resources to research/understand basic medical terminology and drug information and perform basic pharmacy claims data analysis.

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.

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 .

Supplemental Information

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:

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 Angelic Matthews at

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

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

Subscribe to our weekly newsletterto receive a list of new job postings at HCA.

Required Experience:

DescriptionMedical Assistance Specialist 4 (MAS4/FS) Internal onlyThis opportunity is internal and available to current HCA employees only.For individuals who enjoy mastering complex systems and regulations this role offers a chance to develop deep expertise in the Medicaid Drug Rebate program a ni...