Medical Assistance Specialist 4 (MAS4/AHSO) – Internal

State of Washington; Olympia (WA); Remote; USD 90,000 - 120,000; Full time

Benefits offered by this job

Remote work and flexible schedules

Medical, dental, vision, and basiclife

Paid vacation, sick leave, 12 holidays

Paid Family and Medical Leave (PFML)

Retirement options

Training and professional development

Employee wellness programs

Job summary

Washington State Health Care Authority seeks a Medical Assistance Specialist 4 – Internal to lead a team handling pharmacy authorizations and training MAS staff. The role requires deep MAS expertise, policy interpretation, and cross-department collaboration to ensure accurate, compliant decisions.

You will mentor MAS3s, participate in audits, and help shape workflows while maintaining equity in service delivery and high-quality outcomes across Apple Health programs.

Qualifications

• Advanced knowledge of federal/state laws, regulations, policies relevant to complex medical assistance issues.
• Ability to analyze complex program issues and provide well-supported recommendations.
• Experience guiding staff on policy, procedures and work processes.
• Ability to develop and deliver formal training to promote consistent rule application.
• Experience reviewing work for quality, identifying trends and improving processes.
• Ability to interpret policies and communicate guidance to staff and stakeholders.
• Equity-focused decision making and inclusive service delivery.
• Commitment to continuous learning and growth.
• Ability to meet diverse client needs with empathy and clear communication.
• Experience with health care systems, Medicaid knowledge, and prior authorization requirements.

Responsibilities

• Lead Pharmacy Authorization Unit quality control to ensure proper protocol adherence.
• Coach MAS3s; supervise case management of pharmaceutical requests.
• Assist supervisor in reviewing complex authorization decisions.
• Consult with management on policies, problem solving, and workflows.
• Respond to online inquiries about authorizations, policies, and procedures.
• Utilize Provider One and related systems to process high-volume authorizations accurately.
• Monitor providers deviating from standards for compliance.

Skills

Advanced Medical Assistance Program.Ex

Advanced Analysis and Problem Res.

Technical Leadership and Guidance

Training and Knowledge Transfer

Quality Assurance and Program Cons.

Policy and Regulatory Interpretation

Equity lens

Action to learn and grow

Action to meet needs of others

Health Care Systems and Service Del.

Medicaid Knowledge

Client Complaint and Grievance

Medicaid Prior Authorization

Communication and Interpersonal Skills

Staff Training and Leadership

Six years experience/education (Pref)

Health benefits knowledge (Pref)

Public assistance eligibility (Pref)

Training and Leadership (Pref)

Job description

Medical Assistance Specialist 4 – 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

This position leads a team of medical assistance specialists handling pharmacy authorizations by assisting with complex questions, performing quality reviews, and training staff on processes and procedures. They also liaise with other departments, including attending meetings with clinical and other Apple Health staff.

Key Responsibilities

• Performs quality control within the Pharmacy Authorization Unit to ensure adherence to proper protocol and guidelines.
• Trains MAS3s to case manage each request for pharmaceuticals.
• Assists the supervisor and MAS3s in identifying, reviewing, and making final decisions on complex pharmacy authorization requests.
• Consults with management regarding pharmacy policies and procedures, problem solving, workflows, and public relations.
• Responds to on-line inquiries regarding pharmacy authorizations, policies, and procedures.
• Utilizes Provider One, CRM, FlexRx, Right Fax, and Drug Rolodex to ensure a high volume of authorizations are processed accurately.
• Monitors providers identified as deviating from standards set by Pharmacy Program Section for compliance.

Why You’ll Love This Role

• You will lead a team as a subject matter expert.
• You will troubleshoot complex problems that require critical thinking skills.
• You will do a variety of tasks including coaching staff, managing the team’s SharePoint, and meeting with staff from across the division.

What You Bring

• Expertise regarding reviewing and understanding WACs and how they relate to this unit’s work.
• Ability to navigate and balance a high volume and variety of work.

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.

• Advanced Medical Assistance Program Expertise – Demonstrated knowledge of federal and state laws, regulations, policies, procedures, and program requirements applicable to complex medical assistance program issues and circumstances.
• Advanced Analysis and Problem Resolution – Demonstrated proficiency in analyzing complex, unusual, or escalated program issues, evaluating relevant information and requirements, and developing accurate and well-supported determinations, recommendations, or solutions.
• Technical Leadership and Guidance – Demonstrated expertise in providing technical leadership, guidance, consultation, and support to staff and stakeholders regarding complex program requirements, policies, procedures, and work processes.
• Training and Knowledge Transfer – Demonstrated ability 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.
• Quality Assurance and Program Consistency – Demonstrated proficiency in reviewing and evaluating work for accuracy, quality, and compliance; identifying errors, trends, or inconsistencies; and recommending improvements to ensure consistent application of program requirements.
• Policy and Regulatory Interpretation – Demonstrated knowledge of interpreting complex policies, regulations, and program requirements, evaluating their impact on program operations, and communicating appropriate guidance to staff and stakeholders.

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.

• Six years of a combination of experience and/or higher education.
  • Bachelor's degree = four years, associate degree = two years.
  • Experience is 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.
• Health Care Systems and Service Delivery – Demonstrated knowledge of health care organizations, delivery systems, and processes that support access to quality health care services.
• Medicaid Knowledge – Demonstrated understanding of Medicaid, state-managed care programs, and factors impacting client access to quality health care services.
• Client Complaint and Grievance Procedures – Demonstrated knowledge of client complaint and grievance procedures, including processes for addressing concerns and resolving service-related issues.
• Medicaid Prior Authorization Requirements – Demonstrated ability to educate clients, providers, and staff regarding Medicaid prior authorization requirements, procedures, and processes for obtaining covered health care services.
• Communication and Interpersonal Skills – Demonstrated ability to communicate clearly and effectively with individuals and groups, adapting communication styles to meet diverse audiences and organizational needs.
• Staff Training and Leadership – Demonstrated ability to train, guide, and lead staff while modeling respectful behavior, encouraging collaboration, and promoting open and constructive communication.

About the Division

The Apple Health Services and Operations (AHSO) division works across the Health Care Authority (HCA) and in partnership with the health care community at a local, state, and federal level, in developing and managing high quality, evidence-based health care programs and purchase services that enhance Apple Health (Medicaid) client's 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 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.

We welcome applicants with different backgrounds, experiences, identities, and perspectives.

Applicant Eligibility

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.