Medical Assistance Specialist 3 (MACSC)

This job posting is being used to fill multiple positions, and will remain open until filled. Screening of application materials will begin immediately and will be on-going. It is in the applicants' best interest to submit their application materials as early as possible. The hiring manager reserves the right to make a hiring decision at any time. This job posting may be closed at any time without notice.
 
In a customer service and call center environment provides consultative services to clients, providers, and other external customers. Explains scope of care in regards to medical benefits, enrolls Washington Apple Health (Medicaid) clients into managed care plans. Resolves procedural problems involving clients, insurance carriers or providers, researches and resolves complex inquiries regarding claims, problems, and conflicts. This supports the mission of providing quality services that enhance our clients' ability to obtain and access health care.
 
This section is responsible for providing timely and accurate adjudication of claims for providers who provide services to Medicaid clients.
 
Some duties of this position: 

• Within Medicaid Eligibility Community Support (MECS), independently reviews cases and situations to make timely and accurate decisions. Provides expert consultation to clients, providers, Managed Care Organizations (MCO), local community service offices (CSO), and stake holders regarding benefits and services provided by the Apple Health (Medicaid) program, and other state programs via toll-free lines and written correspondence.
• Counsels callers on changes in policy, billing guides and P1 text files. Promote knowledge of policy and laws in assisting providers with their claims submission, payment and provides self-service resources.
• Assist clients with issues concerning eligibility, policy, billing complaints, transportation, access to care, and manage care plans enrollments, exemptions and disenrollment's.

• Counsels effectively and advises all customers on Health Care Authority (HCA) policies, scope of care, clients' rights and responsibility and Medical Assistance policy, procedure and health benefits as outlined in RCW and WAC. Tactfully handle difficult individuals and provides quality customer services.
• Analyzes, negotiates and resolves complex client and provider issues or technical problems with a high degree of independence.
• Coordinates service referral, eligibility information and managed care membership information between managed care plan, local community services offices, other state agencies, community service organizations, medical and social services providers. Assists customers in resolving disputes and other issues related to their Benefit Service Package or Managed Care Plan, reissues Services Card and provides self-service resources.
• Resolves complex questions, claims issues, complaints and problems about eligibility, accessibility to services, enrollment and other insurance coverage.  Uses information, questions and complaints from clients and client advocates to enhance program policy and procedures.
• Assists customers in determining managed care eligibility, selecting and enrolling in or changing managed care plans and resolving issues regarding client health care choices and access to medical services.
• Analyzes, evaluates and assists with claims submission for medical and social service providers for correct adjudication and provider payment.
• Provides information regarding programs and services responding to customers via USPS mail and ContactUs email.
• Researches and identifies workflow and system problems, implements new and revised procedures and reports ongoing system operations.  Deals with the broader aspect of Provider One Payment System (P1) activities as well as individual claims and provider activities.

• Experience performing conflict resolution with customers
• Knowledge of Medicaid programs and eligibility
• Experience utilizing Microsoft Office programs such as Outlook, Word, and SharePoint

• A cover letter
• Current resume
• Three professional references