Medical Assistance Specialist 4 (Lead) – Internal

State of Washington; Olympia (WA); Remote; USD 85,000 - 105,000; Full time

Benefits offered by this job

Remote work

Health insurance

Paid time off and holidays

PFML

Retirement options

Training & development

Wellness programs

Job summary

The State of Washington is seeking a Medical Assistance Specialist 4 (Lead) to oversee a team handling Apple Health (Medicaid) and CHIP cases. The role centers on guiding complex eligibility determinations, delivering training, and stepping in for supervision to maintain smooth operations.

You will lead day-to-day operations, apply federal and state rules, and coordinate across systems like ACES/ProviderOne, ensuring accurate, compliant outcomes while working primarily remotely with occasional

Qualifications

• Demonstrated advanced knowledge of federal and state laws, regulations, policies, procedures, and program requirements.
• Ability to analyze complex, unusual, or escalated program issues and develop accurate determinations.
• Provide technical leadership, guidance, and expertise to staff and partners.

Responsibilities

• Lead a team of eight or more Medical Assistance Specialists, monitoring workload and priorities.
• Act on behalf of the supervisor in their absence to support daily operations.
• Provide staff with eligibility guidance, interpret policy, and help determine final dispositions.

Skills

Policy knowledge

Regulatory interpretation

Staff training

Leadership

Audit & compliance

Team coordination

Communication

Equity mindset

Tools

ACES

ProviderOne

Barcode/DMS

Washington Healthplanfinder

MVP

Job description

Medical Assistance Specialist 4 (Lead) – Internal

This is a full-time, permanent, remote position. Employees may occasionally be asked to attend an in-person meeting or event based on business needs.

This is an internal opportunity and is only open to current HCA employees.

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

The Opportunity

Lead a team that connects Washington residents to 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 4 to serve as the lead worker for a team of eight or more Medical Assistance Specialists. As the team's eligibility expert, you will guide staff through complex Apple Health (Medicaid) and Children's Health Insurance Program (CHIP) cases, develop and deliver training, and step in for the supervisor when needed to keep day-to-day operations running smoothly.

Key Responsibilities

• Serve as lead worker for a team of eight or more Medical Assistance Specialists, monitoring team workload and priorities.
• Act on behalf of the supervisor in their absence and support the team's day-to-day operations.
• Provide eligibility support and clarification to staff, interpret policy and regulations, and help determine the final disposition of complex eligibility cases.
• Apply complex federal and state eligibility rules (WAC and RCW) to household circumstances to make accurate initial and ongoing eligibility decisions.
• Develop and deliver eligibility, systems, interviewing, and workload management training for new and experienced staff, including training on program changes and identified performance gaps.
• Conduct internal program audits to identify error trends and performance issues.
• Analyze workflow and system problems, and devise and implement new or revised procedures.
• Use multiple interconnected systems, including the Automated Client Eligibility System (ACES), ProviderOne, and the Document Management System (DMS).
• Research, prepare, and represent agency in administrative hearings, and partner with advocates, providers, and Community Services Offices to resolve issues.

Why You’ll Love This Role

• You’ll help ensure individuals and families across Washington get accurate, timely access to health coverage.
• You’ll build your leadership experience by coaching, training, and guiding a team of eligibility specialists.
• You’ll be the go-to expert your team relies on, with your knowledge shaping how the work gets done.
• You’ll lead your team primarily remotely, with occasional opportunities to connect in person.

What You Bring

You are a patient teacher and a steady leader who enjoys helping others grow. You stay calm when cases get complicated, take a thoughtful approach to problem-solving, and hold yourself to a high standard of accuracy. You communicate clearly with staff, managers, and customers, maintain confidentiality, and support your team and management with professionalism. You are always looking for ways to improve how the work gets done.

Required Qualifications

Experience may have been gained through paid or unpaid activities. Please ensure any relevant experience defined below is outlined in your cover letter, resume, and application.

• Demonstrated ability to apply advanced knowledge of federal and state laws, regulations, policies, procedures, and program requirements to complex medical assistance program issues and circumstances.
• Demonstrated skill to analyze complex, unusual, or escalated program issues, evaluate relevant information and requirements, and develop accurate and well-supported determinations, recommendations, or solutions.
• Demonstrated knowledge to provide technical leadership, guidance, consultation, and expertise to staff and partners regarding complex program requirements, policies, procedures, and work processes.
• Demonstrated proficiency to develop, deliver, or support formal training and provide coaching and technical instruction that promotes accurate and uniform application of program rules, policies, procedures, and requirements.
• Demonstrated ability to review and evaluate work for accuracy, quality, and compliance; identify errors, trends, or inconsistencies; and provide guidance or recommendations to improve consistent application of program requirements.
• Demonstrated skill to interpret complex policies, regulations, and program requirements; evaluate their impact on program operations; and provide technical guidance regarding appropriate implementation and application.
• Demonstrated proficiency to coordinate and prioritize work, provide direction and technical assistance to staff, monitor workflow, and support effective and timely completion of program responsibilities.
• Demonstrated ability to communicate complex, sensitive, or technical program information and provide effective consultation to staff, management, providers, customers, and other partners.

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’ve learned 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

While these are not required, having them may help you stand out as an applicant.

• Experience as a Medical Assistance Specialist 3.
• 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-related experience.
• Demonstrated experience with ACES, Washington Healthplanfinder, MVP, ProviderOne, and/or Barcode/DMS.

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 the 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 programsLearn more about Washington State Employee Benefits

Work location and schedule:

This is a full-time 40-hour-per-week remote position. Our standard business hours are Monday through Friday, 8 a.m. to 5 p.m., with alternative work schedules considered based on business needs and supervisor approval. In this role you will 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.

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.