Medicaid Eligibility Specialist III

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

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.