Remote Medicaid Benefits Specialist

State-of-Washingto; Olympia (WA); Remote; USD 65,000 - 90,000; Full time

Benefits offered by this job

Tuition reimbursement

Free parking

Mobile work options

Job summary

Washington State Health Care Authority is hiring a Health Benefits Specialist 3 to provide expert guidance on Apple Health (Medicaid) benefits and managed care enrollment in a primarily remote role. You will resolve complex claims, advise providers and clients, and coordinate across state agencies and service organizations to ensure accurate benefit delivery.

The role emphasizes equity, professional communication, and meticulous compliance, with flexible onsite needs based on operations and the

Qualifications

• Demonstrated ability to interpret and apply applicable federal and state laws, regulations, policies, procedures, and program requirements related to medical assistance programs, benefits, eligibility, enrollment, services, or claims.
• Demonstrated ability to independently research, analyze, and evaluate complex information to make accurate determinations and resolve program-related issues within established authority.
• Demonstrated ability to provide accurate technical information, consultation, and assistance to customers, providers, members, partners, and other stakeholders regarding medical assistance programs and requirements.
• 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.
• Demonstrated ability to independently produce accurate, complete, and timely work while ensuring compliance with applicable laws, regulations, policies, procedures, and established program standards.
• Demonstrated ability to independently organize and prioritize complex assignments, manage competing demands, meet established timelines, and judgment with limited supervisory direction.

Responsibilities

• Provides expert consultation to clients, providers, Managed Care Organizations (MCO), local CSOs, and stakeholders regarding benefits and services provided by Apple Health (Medicaid) in a call center environment and in writing.
• Counsels and advises customers on HCA policies, scope of care, clients’ rights and responsibility, and Medical Assistance policy, procedure, and health benefits.
• Tactfully manages difficult situations and provides quality customer service.
• Coordinates service referral, eligibility information, and managed care membership information between managed care Plan, CSOs, other state agencies, community service organizations, and medical and social services providers.
• Assists customers in resolving disputes and other issues related to their benefit service package or managed care plan.
• Resolves complex questions, claims issues, complaints, and problems about eligibility, accessibility to services, enrollment, and other insurance coverage.
• Assists customers in determining managed care eligibility, selecting and enrolling in or changing managed care plans, and resolving issues regarding health care choices and access to medical services.
• Analyzes, evaluates, and assists with claims submission for medical and social service providers.
• Maintains a thorough knowledge of ProviderOne (P1), POS, ACES, Treasury Management System (TMS), Siebel, Avaya, Title XIX policy, HealthPlanfinder, and medical terminology.

Skills

Medical Assistance Program Knowledge

Independent Analysis and Determination

Customer and Stakeholder Consultation

Professional Communication

Quality, Accuracy, and Compliance

Workload and Priority Management

Education

Bachelor’s degree + 1 year experience in health benefits or related field

Associate degree + 3 years experience in health services

Five years of related experience

1 year as Medical Assistance Specialist 2

Tools

ACES

ProviderOne (P1)

Siebel

Job description

Washington State Health Care Authority is hiring a Health Benefits Specialist 3 to provide expert guidance on Apple Health (Medicaid) benefits and managed care enrollment in a primarily remote role. You will resolve complex claims, advise providers and clients, and coordinate across state agencies and service organizations to ensure accurate benefit delivery.

The role emphasizes equity, professional communication, and meticulous compliance, with flexible onsite needs based on operations and the