Dental Authorization Specialist (MAS3CQCT)

Dental Authorization Specialist (MAS3/CQCT)

The salary advertised reflects the statewide 2% GWI for employees as of 7/1/2026.

This recruitment will be used to fill multiple positions.

This Medical Assistance Specialist 3 reviews complex dental and orthodontic prior authorization requests as they pertain to Medicaid guidelines. This position communicates with providers to ensure proper documentation has been submitted to determine medical necessity. This position requires significant accuracy so if you are highly detail-oriented with customer service skills this may be the opportunity 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 Clinical Quality and Care Transformation (CQCT) Division is responsible for designing and implementing clinical policy; conducting oversight including measuring monitoring and improving all clinically related programs; and communicating and collaborating with stakeholders providers plans and delivery system partners on clinical activities and issues with the goal to provide a single standard of evidence-informed high-quality care.

About the position:

This position supports the mission and vision as we work together to provide quality services that enhance our clients ability to obtain and access health care by providing senior consultative services to providers. Prior authorization protects clients from unproven or risky procedures tests or medications that may be harmful and do not meet evidence-based guidelines of effective treatment.

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. All agency employees are required to report on-site in Olympia on their first and last days of employment to pick up and return state-issued equipment regardless of telework status or location.

Some of what you will do:

• Review analyze and process incoming dental and orthodontic prior authorization requests for validity and compliance applying policies as well as state and federal rules and regulations.
• Evaluate individual dental requests for appropriateness completeness compliance with established dental and medical standards regulations and policies dental and medical contraindications and medical necessity. When appropriate communicate with providers to obtain medical justification.
• While processing requests maintain an acceptable office error rate of less than three percent.
• Resolve complex issues related to the dental/orthodontic program through communication with providers and other HCA staff to resolve complex issues.
• Notify clients and providers of decisions through clear and concise technical correspondence based on medical necessity of the service requested.
• Provide consultative services to providers HCA staff and other state agency staff with respect to the dental/orthodontic program.
• Verify client eligibility and whether request requires prior authorization based on program rules and guidelines.
• Review documents to ensure all required documentation was submitted. Notify and educate submitting providers office as to what information is required if needed.
• Refer and/or collaborate with Provider Review and Audit Section if specific provider trends are identified that need to be addressed.
• Investigate analyze or resolve claims issues and pricing problems related to authorized services through collaboration with Provider Relations and Claims Processing teams.

Required qualifications:

Qualifying candidates will also meet one of the following criteria options:

Option 1:

• Bachelors degree in healthcare administration business administration or a related field and
• One (1) year of experience working in a dental office setting which includesa working knowledge of:
  • 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.

Option 2:

• Associate degree in healthcare administration business administration or a related field Certificate of Medical Billing and Coding or a related certificate and
• Three (3) years of experience working in a dental office setting which includes experience as described above.

Option 3:

• Five (5) years of experience working in a dental office setting which includes experience as described above.

Option 4:

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

Required competencies:

• The ability to take action to learn and grow.
• The ability to take action to meet the needs of others.
• Working knowledge of health insurance disability or other related health benefits.
• Demonstrated ability to handle large volumes of work.
• Demonstrated ability to meet timelines.
• Knowledge of dental terminology.

Preferred qualifications:

• Experience and knowledge in the Provider One system (MMIS).
• Knowledge of Washington Administrative Codes (WACs) related to prior authorization agency-administered programs and the HCA Medicaid Provider Guides.
• Ability to use multiple software applications (e.g. Microsoft Word Excel Access and Outlook).

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 .

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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