Medicaid Eligibility Specialist (Hybrid)

Washington State Health Care Authority; Federal Way (WA); Hybrid; USD 70,000 - 90,000; Full time

Benefits offered by this job

Remote work options

Paid vacation and holidays

Paid Family and Medical Leave (PFML)

Training and professional development

Employee wellness programs

Job summary

Washington State Health Care Authority seeks a Medical Assistance Specialist 3 based in Federal Way Public Health. This full-time, hybrid role determines eligibility for Apple Health (Medicaid) and CHIP, applying federal and state rules in complex cases with onsite client interviews and phone communications.

You will collaborate with advocates, providers, and state agencies, using multiple systems to verify documents and support eligible Washington residents while contributing to MEDS operations

Qualifications

• Ability to interpret and apply regulations, policies, and procedures.
• Independently research, analyze, and evaluate complex information to determine eligibility.
• Identify, analyze, and resolve complex issues with minimal supervision.
• Research and interpret complex program rules and apply findings to cases.
• Provide accurate technical information and assistance to customers and partners.
• Communicate complex information clearly, verbally and in writing.
• Produce accurate, timely work while adhering to laws and policies.
• Organize and prioritize complex assignments with sound judgment.

Responsibilities

• Independently determine initial and ongoing eligibility for Medicaid and CHIP.
• Apply federal/state rules to individual household circumstances to authorize benefits.
• Research and resolve complex eligibility issues with independence.
• Use ACES, Washington Healthplanfinder, ProviderOne, and DMS effectively.
• Conduct onsite client interviews and coordinate documentation for eligibility.
• Update eligibility records and help expand access to care.
• Coordinate with advocates, providers, and agencies to resolve questions.
• Participate in process improvements for MEDS operations.

Skills

Independent analysis

Complex problem resolution

Technical research & interpretation

Customer & partner consultation

Professional communication

Quality and compliance

Workload & priority management

Education

Bachelor's or Associate degree

Tools

ACES

Washington Healthplanfinder

ProviderOne

Document Management System (DMS)

Microsoft Office (Outlook, Word, SharePoint)

Job description

Washington State Health Care Authority seeks a Medical Assistance Specialist 3 based in Federal Way Public Health. This full-time, hybrid role determines eligibility for Apple Health (Medicaid) and CHIP, applying federal and state rules in complex cases with onsite client interviews and phone communications.

You will collaborate with advocates, providers, and state agencies, using multiple systems to verify documents and support eligible Washington residents while contributing to MEDS operations