Hybrid Medicaid Eligibility Specialist

State of Washington; Federal Way (WA); Hybrid; USD 65,000 - 90,000; Full time

Benefits offered by this job

Remote work

Flexible schedules

Health insurance (medical, dental, and

Vision coverage

Paid vacation and holidays

Paid Family and Medical Leave

Retirement options

Training and professional development

Wellness programs

Job summary

State of Washington’s Health Care Authority is hiring a Medical Assistance Specialist 3 in Federal Way. The role determines eligibility for Apple Health (Medicaid) and CHIP, applying federal and state rules with onsite interviews and hybrid work arrangements.

This full-time position supports WA residents by connecting them to health coverage. You’ll collaborate with partners and use systems like ACES, Healthplanfinder, ProviderOne, and DMS to ensure accurate determinations and timely benefits.

Qualifications

• Demonstrated ability to interpret and apply regulations, policies, and procedures.
• Independent research, analysis, and evaluation of complex information to make determinations.

Responsibilities

• Independently determine initial and ongoing eligibility for Medicaid Title XIX, CHIP Title XXI, and other Medicaid and state-funded programs.
• Apply complex federal and state eligibility rules to individual circumstances to authorize benefits.
• Research and resolve complex eligibility issues with a high degree of independence.
• Conduct onsite client interviews and coordinate documentation by phone and in writing.
• Answer inquiries and maintain eligibility records to expand access to care.
• Partner with advocates, providers, and state agencies to resolve disputes and coordinate referrals.
• Participate in process improvement efforts to streamline MEDS operations.

Skills

Regulations interpretation

Independent analysis

Complex problem resolution

Technical research

Customer consultation

Professional communication

Quality and compliance

Workload management

Education

Bachelor's or Associate degree

Tools

ACES

Washington Healthplanfinder

ProviderOne

Document Management System (DMS)

Job description

State of Washington’s Health Care Authority is hiring a Medical Assistance Specialist 3 in Federal Way. The role determines eligibility for Apple Health (Medicaid) and CHIP, applying federal and state rules with onsite interviews and hybrid work arrangements.

This full-time position supports WA residents by connecting them to health coverage. You’ll collaborate with partners and use systems like ACES, Healthplanfinder, ProviderOne, and DMS to ensure accurate determinations and timely benefits.