Lobby - Medical Assistance Specialist 3 (MAS3/AHEA)

State of Washington; Olympia (WA); Sur place; USD 65 000 - 90 000; Plein temps

Résumé du poste

The State of Washington’s Health Care Authority seeks a Medical Assistance Specialist 3 to determine eligibility for Apple Health and related programs. This in-person role requires interviewing residents, applying complex rules, and using ACES, Healthplanfinder, ProviderOne, and DMS to support accurate determinations.

Located in Olympia, WA, the position emphasizes independent analysis, customer service, and collaboration with partners to resolve issues and improve MEDS operations.

Qualifications

• Interpret and apply regulations, policies, and procedures.
• Independently research, analyze, and evaluate complex information to make determinations.
• Identify, analyze, and resolve complex issues.
• Research and interpret complex program rules and apply findings.
• Provide accurate technical information and assistance to customers and partners.
• Communicate clearly, both verbally and in writing.
• Work independently while ensuring compliance with laws and standards.
• Organize and prioritize complex assignments with limited supervision.

Responsabilités

• Independently determine initial and ongoing eligibility for Medicaid, CHIP, and other programs.
• Apply federal and state rules to household circumstances to authorize benefits.
• Research and resolve complex eligibility issues with minimal supervision.
• Use multiple systems (ACES, Healthplanfinder, ProviderOne, DMS) to support determinations.
• Interview clients and others to gather documentation for eligibility.
• Provide direct, face-to-face customer support in the lobby office.
• Collaborate with advocates, providers, and agencies to resolve questions and coordinate referrals.
• Assist with process improvements to streamline MEDS operations.

Connaissances

Regulations interpretation

Independent analysis

Complex problem solving

Technical research

Customer consultation

Professional communication

Quality and compliance

Workload management

Formation

Bachelor's degree in a related field

Outils

ACES

Washington Healthplanfinder

ProviderOne

Document Management System (DMS)

Description du poste

Lobby - Medical Assistance Specialist 3

This is a full-time permanent, in-person position based at our office in Olympia, WA.

All HCA employees are required to be Washington state residents upon their first day of employment.

The Opportunity

Help Washington residents get the health coverage they need. The Medical Eligibility Determination Services (MEDS) office in HCA's Apple Health Eligibility and Access (AHEA) Division is seeking a Medical Assistance Specialist 3 to determine eligibility for Apple Health (Medicaid), the Children's Health Insurance Program (CHIP), and other state-funded medical assistance programs. In this role, you will independently apply federal and state eligibility rules to each household's unique circumstances and serve the public face-to-face in one of HCA's lobby offices, by phone, and in writing.

Key Responsibilities

• Independently determine initial and ongoing eligibility for Medicaid Title XIX, CHIP Title XXI, and other Medicaid and state-funded medical assistance programs administered by MEDS.
• Apply complex federal and state eligibility rules (WAC and RCW) to individual household circumstances to make accurate eligibility decisions and authorize benefits.
• Research and resolve complex eligibility issues with a high degree of independence.
• Use multiple interconnected systems, including the Automated Client Eligibility System (ACES), Washington Healthplanfinder, ProviderOne, and the Document Management System (DMS).
• Interview clients, providers, and third parties by phone, in person, and in writing to gather the documentation and verification needed to support eligibility.
• Provide direct, face-to-face customer support to the public in one of HCA's lobby offices.
• Partner with advocates, providers, the Health Benefit Exchange, other state agencies, and community-based organizations to answer questions, resolve disputes, and coordinate referrals.
• Support Take Charge family planning providers with eligibility questions and take part in process improvement efforts that streamline MEDS operations.

Why You’ll Love This Role

• You’ll make a direct difference for individuals and families by connecting them to the health coverage they need.
• You’ll build deep expertise in Medicaid eligibility, a skill set that opens doors across HCA and public service.
• You’ll join a collaborative team that invests in ongoing training and values your ideas for improving how the work gets done.
• You’ll work a predictable Monday through Friday schedule in a role where every day brings new people to help.

What You Bring

You are patient, steady, and genuinely enjoy helping people, even in difficult conversations. You handle challenging interactions with tact and diplomacy, and you build positive working relationships with clients, their advocates, and your coworkers. You are detail-oriented and self-directed, take pride in getting things right, and stay organized when the work gets busy. You are eager to keep learning and look for ways to make processes work better for the people we serve.

Required Qualifications

• Demonstrated ability to interpret and apply regulations, policies, and procedures.
• Independent Analysis and Determination: Demonstrated ability to independently research, analyze, and evaluate complex information to make accurate determinations and resolve program-related issues within established authority.
• Complex Problem Resolution: Demonstrated ability to identify, analyze, and resolve complex issues.
• Technical Research and Interpretation: Demonstrated ability to research and interpret complex program rules, regulations, policies, procedures, and other authoritative information and appropriately apply findings to individual circumstances.
• Customer and Partner Consultation: Demonstrated experience providing accurate technical information, consultation, and assistance to customers, providers, members, and other partners regarding complex issues and requirements.
• Professional Communication: Demonstrated ability to communicate complex or technical information clearly, accurately, and professionally, both verbally and in writing, to individuals with varying levels of program knowledge.
• Quality, Accuracy, and Compliance: Demonstrated ability to independently produce accurate, complete, and timely work while ensuring compliance with applicable laws, regulations, policies, procedures, and established program standards.
• Workload and Priority Management: Demonstrated ability to independently organize and prioritize complex assignments, manage competing demands, meet established timelines, and exercise sound judgment with limited supervisory direction.

Required Competencies

• Equity lens – All HCA employees are required to consider equity in their decisions, processes, and day-to-day work, including how their work may affect the people and communities we serve.
• The ability to take action to learn and grow – You take action to learn and grow by seeking new perspectives, learning from experiences, and using what you’ll learn to continuously improve how you work and serve others.
• The ability to take action to meet the needs of others – You take action to meet the needs of others by listening, understanding different perspectives, and responding with care, respect, and solutions that support the people of the communities we serve.

Preferred Qualifications

• Demonstrated ability to resolve conflicts with customers in person, professionally and effectively, while maintaining positive working relationships.
• Demonstrated ability to effectively use Microsoft Office applications, including Outlook, Word, and SharePoint, to support business operations and communication.
• Experience as a Medical Assistance Specialist 2 or Medical Assistance Specialist 3.
• Demonstrated ability to apply knowledge of Medicaid programs and eligibility requirements when performing assigned work.
• Demonstrated ability to effectively use Microsoft Office applications, including Outlook, Word, and SharePoint, to support business operations and communication.
• A bachelor's degree in a related field.
• Demonstrated professional experience 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; or other medical premiums/claims/eligibility-related experience; or experience researching and analyzing complex rules, regulations, and policies to make determinations and resolve problems while providing direct customer service.

About the Apple Health Eligibility and Access (AHEA) Division

The Apple Health Eligibility and Access (AHEA) Division works across the Health Care Authority and in partnership with the health care community at the local, state, and federal levels to develop and manage high-quality, evidence-based health care programs and purchase services that enhance Washington residents' ability to access appropriate, quality health care.

About the Washington State Health Care Authority

Better Health. Better Care. A Healthier Washington.

At HCA, we work to ensure people across Washington have the opportunity to be as healthy as possible. As the State’s largest health care purchaser and behavioral health authority, HCA serves nearly 3 million Washington residents through Apple Health (Medicaid), Public Employees Benefits Board (PEBB) and School Employees Benefits Board (SEBB) programs, and behavioral health services. Through this work, HCA purchases and coordinates care coverage, supports behavioral health prevention, treatment, crisis response, and recovery and helps strengthen access to high-quality care across Washington.

More than a benefits package:

We want our employees to have the support, flexibility, and benefits they need to do their best work and build a career that works for their life. As a Washington State HCA employee, you’ll have access to a comprehensive benefits package that supports your health, financial well-being, and work-life balance. Our benefits are designed to support you today while helping you plan for the future. Learn more about why HCA by visiting Voices of HCA and the Who we are section of our website.

Your total compensation is more than your paycheck:

• Remote work and flexible schedules
• Medical, dental, vision, and basic life insurance
• Paid vacation, sick leave, and 12 paid holidays
• Paid Family and Medical Leave (PFML)
• Retirement options to plan for the future
• Training and professional development opportunities
• Employee wellness programs
• Learn more about Washington State Employee Benefits

Work Location and Schedule

This is a full-time 40-hour-per-week in-person position based at our office located in Olympia, WA. Our standard business hours are Monday through Friday, 8 a.m. to 5 p.m., with alternative work schedules considered based on business needs. Work will be conducted in a shared space, open office environment. In this role you’ll regularly collaborate with colleagues, agency leaders, state and federal partners, and other external partners or customers. Occasional travel may be required for meetings, training, or other business needs. All employees are required to report to our Olympia office on their first and final day of employment.

Our commitment to an inclusive workplace:

The Health Care Authority is an equal opportunity employer. We are committed to creating a workplace where employees are respected, included, and supported in bringing their experiences, perspectives, and ideas to work. Our commitment to inclusion is reflected in how we work together and serve the people of Washington. HCA also supports five voluntary employee led Employee Resource Groups (ERGs), which create opportunities for connection, community, learning, and professional growth.

Union Representation

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

Veterans

We value the experience and skill veterans bring to the workforce and encourage veterans, transitioning service members, and military spouses to apply. Eligible veterans may qualify for veterans’ preference in accordance with Washington State Law. If you are claiming veterans’ preference, you must attach your applicable DD-214 documentation to your application. Please redact your social security number, date of birth, and any other sensitive information before uploading and attaching the document.

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.