Authorization Specialist (MAS3/CQCT)

Salary : $44,000.00 - $59,616.00 Annually

Location : Thurston County - Olympia, WA

Job Type: Full Time - Permanent

Remote Employment: Remote Optional

Job Number: 2024-04675

Department: Health Care Authority

Division: CQCT

Opening Date: 04/15/2024

Closing Date: 4/25/2024 11:59 PM Pacific

Salary Information: The high end of the salary range, Step M is typically a longevity step

Description

Medical Assistance Specialist 3 (MAS3/CQCT)

This posting is being used to fill multiple positions.

Are you ready to make a difference? Join our dynamic team and play a crucial role in advancing our agency's mission! We are seeking a skilled individual to provide consultative services to both providers and clients while independently determining prior authorization for medical services and equipment. If you're passionate about improving healthcare delivery and thrive in a fast-paced environment, we want to hear from you! Join us and be part of a team dedicated to making a meaningful impact on the lives of others.

All HCA employees will apply an equity lens to their work, which may include but is not limited to all analyses of core business and processes.

About the division:

The mission of Clinical Quality and Care Transformation (CQCT) division is to work together to provide quality services that enhance our client's ability to obtain and access health care. This position supports the agency and division's mission by providing expert consultative services to providers and clients and independently determining prior authorization of medical services and equipment.

About the position:
This position supports mission of Health Care Authority/Clinical Quality and Care Transformation (CQCT) is to work together to provide quality services that enhance our client's ability to obtain and access health care. This position supports that mission by providing expert consultative services to providers and clients and independently determining prior authorization of medical services and equipment.

This position is eligible to telework and is typically not required to report on-site. The default assigned work location of all Health Care Authority (HCA) positions - both on-site and telework eligible positions - is within the State of Washington. Frequency of onsite work will vary based on business and operational needs. HCA may choose, but is not required, to support out-of-state telework on a case-by-case basis.

Duties

Some of what you will do:
Based on guidelines, make approval decisions on prior authorization requests and/or route the request to the appropriate clinical staff.
Correlates data obtained from sources outside the department to build history on specific clients. Determines allowed payment based on manufacturer information and WAC pricing and methodology.
Communicate with providers to answer questions regarding their requests and educate providers on program policy and/or criteria.
Provide support to the authorization units through a centralized process by receiving requests and inputting requests into the Provider One system and internal data systems.
Notify Supervisor/Lead when WAC citations appear to be incorrect, inappropriately applied, or reasons for denial/approval are not clear when received from clinical staff.
Document coverage decision in Provider One and notify the provider and client of the decision within established WAC timelines as they relate to procession requests and notifying providers and clients is essential.
Process requests received by fax or mail for Exception to Rule/Limited Extensions (ETR/LE) and individual requests generated by various providers.
Determine client eligibility and determine if requests require prior authorization based on program rules/guidelines for each request.
Review documents to determine if all required documentation was submitted, if not, notify and educate the providers what information is required to submit a request, program rules and what additional information is needed to process requests.
Refer and/or collaborate with ISD and Provider integrity if specific provider trends are identified where requests seem unusual or inappropriate. Investigate, analyze, or resolve, through collaboration with the Division of Budget and Finance and Provider Relations, claims processing regarding claims issues, pricing problems related to services that are authorized.
Participate in continual process improvement endeavors and revise, as necessary, prior authorization processes and procedures, database modifications/maintenance and forms development.
Stay up to date with the ongoing program changes in Billing Instruction and WAC's.
Participate in multidisciplinary meetings relative to reporting, WAC development, Billing Instructions, policy decisions and changes, and program review, to provide a different perspective.
Train new staff, complete work on special projects and/or assignments.
Serve on committees and assist other units within the office as requested.
Qualifications

Required qualifications: A bachelor's degree and one (1) year of 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.
OR An associate degree and three (3) years of 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.
OR Five (5) years of 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.
OR One (1) year as a Medical Assistance Specialist 2
Preferred qualifications: Experience and knowledge in the Provider One system (MMIS) and systems such as Document Management Systems,
Barcode and ACES, knowledge of medical terminology, Washington Administrative Codes related to prior authorizations and Agency administered programs, and Health Care Authority Medicaid Billing Instructions.
Ability to use multiple software applications, e.g. Microsoft Word, Microsoft Excel, Microsoft Access, and Outlook.
How to apply:

Only candidates who reflect the minimum qualifications on their NEOGOV profile will be considered. Failure to follow the application instructions below may lead to disqualification. To apply for this position, you will need to complete your profile which includes three professional references and attach: A cover letter that specifically addresses how you meet the qualifications for this position.
Current resume
To take advantage of veteran preference , please do the following: Attach a copy of your DD214 (Member 4 long-form copy), NGB 22, or USDVA signed verification of service letter.
Please black out any PII (personally identifiable information) data such as social security numbers. Include your name as it appears on your application in careers.wa.gov.
Supplemental Information

About HCA:
Functioning as both the state's largest health care purchaser and its behavioral health authority, the Washington State Health Care Authority (HCA) is a leader in ensuring Washington residents have the opportunity to be as healthy as possible.

There are three pillars of our work: Apple Health (Medicaid); the Public Employees Benefits Board (PEBB) and School Employees Benefits Board (SEBB) programs; and behavioral health and recovery. Under these pillars, HCA purchases health care, including behavioral health treatment for more than 2.7 million Washington residents and provides behavioral health prevention, crisis, and recovery supports to all Washington residents.

What we have to offer: Meaningful work with friendly co-workers who care about those we serve Voices of HCA
A clear agency mission that drives our work and is person-centered HCA's Mission, Vision & Values
A healthy work/life balance, including alternative/flexible schedules and mobile work options.
A great total compensation and benefit package WA State Government Benefits
A safe, pleasant workplace in a convenient location with restaurants, and shopping nearby.
Tuition reimbursement
And free parking!

Notes:

This position is covered by the Washington Federation of State Employees (WFSE). Once the listed position(s) is(are) filled, this recruitment announcement may also be used to fill additional position(s) for up to sixty (60) days.

Prior to a new hire, a background check including criminal record history will be conducted. Information from the background check will not necessarily preclude employment.

HCA is an equal opportunity employer. We value the importance of creating an environment in which all employees can feel respected, included, and empowered to bring unique ideas to the agency. HCA has five employee resource groups (ERGs). ERGs are voluntary, employee-led groups whose aim is to foster a diverse, inclusive workplace aligned with HCA's mission. Our diversity and inclusion efforts include embracing different cultures, backgrounds and viewpoints while fostering growth and advancement in the workplace. Women, racial and ethnic minorities, persons of disability, persons over 40 years of age, disabled and Vietnam era veterans, as well as people of all sexual orientations and gender identities are encouraged to apply. Persons with disabilities needing assistance in the application process, or those needing this job announcement in an alternative format may contact Julie Laney at (253) 725.5130 or .

The Washington State Health Care Authority (HCA) is an . All applicants with a in the United States are encouraged to apply.

E-Verify® is a registered trademark of the U.S. Department of Homeland Security.

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More than Just a Paycheck!
Employee benefits are not just about the kind of services you get, they are also about how much you may have to pay out of pocket. Washington State offers one of the most competitive benefits packages in the nation.

We understand that your life revolves around more than just your career. Like everyone, your first priority is ensuring that you and your family will maintain health and financial security. That's why choice is a key component of our benefits package. We have a selection of health and retirement plans, paid leave, staff training and other compensation benefits that you can mix and match to meet your current and future needs.

Read about our benefits:
The following information describes typical benefits available for full-time employees who are expected to work more than six months. Actual benefits may vary by appointment type or be prorated for other than full-time work (e.g. part-time); view the job posting for benefits details for job types other than full-time.

Note: If the position offers benefits which differ from the following, the job posting should include the specific benefits.

Insurance Benefits
Employees and their families are covered by medical (including vision), dental and basic life insurance. There are multiple medical plans with affordable monthly premiums that offer coverage throughout the state.

Staff are eligible to enroll each year in a medical flexible spending account which enables them to use tax-deferred dollars toward their health care expenses. Employees are also covered by basic life and long-term disability insurance, with the option to purchase additional coverage amounts.

To view premium rates, coverage choice in your area and how to enroll, please visit the Public Employees Benefits Board (PEBB) website. The Washington Wellness program from the Health Care Authority works with PEBB to support our workplace wellness programs.

Dependent care assistance allows the employee to save pre-tax dollars for a child or elder care expenses.

Other insurance coverage for auto, boat, home, and renter insurance is available through payroll deduction.

The Washington State Employee Assistance Program promotes the health and well-being of employees.

Retirement and Deferred Compensation
State Employees are members of the Washington Public Employees' Retirement System (PERS). New employees have the option of two employer contributed retirement programs. For additional information, check out the Department of Retirement Systems' web site.

Employees also have the ability to participate in the Deferred Compensation Program (DCP). This is a supplemental retirement savings program (similar to an IRA) that allows you control over the amount of pre-tax salary dollars you defer as well as the flexibility to choose between multiple investment options.

Social Security
All state employees are covered by the federal Social Security and Medicare systems. The state and the employee pay an equal amount into the system.

Public Service Loan Forgiveness
If you are employed by a government or not-for-profit organization, and meet the qualifying criteria, you may be eligible to receive student loan forgiveness under the Public Service Loan Forgiveness Program.

Holidays
Full-time and part-time employees are entitled to paid holidays and one paid personal holiday per calendar year.

Note: Employees who are members of certain Unions may be entitled to additional personal leave day(s), please refer to position specific Collective Bargaining Agreements for more information.

Full-time employees who work full monthly schedules qualify for holiday compensation if they are employed before the holiday and are in pay status for at least 80 nonovertime hours during the month of the holiday; or for the entire work shift preceding the holiday.

Part-time employees who are in pay status during the month of the holiday qualify for the holiday on a pro-rata basis. Compensation for holidays (including personal holiday) will be proportionate to the number of hours in pay status in the month to that required for full-time employment, excluding all holiday hours. Pay status includes hours worked and time on paid leave.

Sick Leave
Full-time employees earn eight hours of sick leave per month. Overtime eligible employees who are in pay status for less than 80 hours per month, earn a monthly proportionate to the number of hours in pay status, in the month to that required for full-time employment. Overtime exempt employees who are in pay status for less than 80 hours per month do not earn a monthly accrual of sick leave.

Sick leave accruals for part-time employees will be proportionate to the number of hours in pay status, in the month to that required for full-time employment. Pay status includes hours worked, time on paid leave and paid holiday.

Vacation (Annual Leave)
Full-time employees accrue vacation leave at the rates specified in (1) or the applicable collective bargaining agreement (CBA). Full-time employees who are in pay status for less than 80 nonovertime hours in a month do not earn a monthly accrual of vacation leave.

Part-time employees accrue vacation leave hours in accordance with (1) or the applicable collective bargaining agreement (CBA) on a pro rata basis. Vacation leave accrual will be proportionate to the number of hours in pay status, in the month to that required for full-time employment.

Pay status includes hours worked, time on paid leave and paid holiday.

As provided in , an employer may authorize a lump-sum accrual of vacation leave or accelerate the vacation leave accrual rate to support the recruitment and/or retention of a candidate or employee for a Washington Management Service position. Vacation leave accrual rates may only be accelerated using the rates established WAC 357-31-165.

Note: Most agencies follow the civil service rules covering leave and holidays for exempt employees even though there is no requirement for them to do so. However, agencies are required to adhere to the applicable RCWs pertaining holidays and leave.

Military Leave
Washington State supports members of the armed forces with 21 days paid military leave per year.

Bereavement Leave
Most employees whose family member or household member dies, are entitled to three (3) days of paid bereavement leave. In addition, the employer may approve other available leave types for the purpose of bereavement leave.

Additional Leave
Leave Sharing

Family and Medical Leave Act (FMLA)
Leave Without Pay

Please visit the State HR Website for more detailed information regarding benefits.

Updated 12-31-2022

01

I acknowledge that I have included at least three references and added a resume and cover letter to the attachments section of my application. Yes
No

02

Please select the highest level of education that you have completed: High school graduation or equivalent
Associate degree
Bachelor's degree
Master's degree or higher
None of the above

03

Which of the following best describes your professional work experience in any or a combination of the following?:• 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. I do not have this experience
Less than 1 year
More than 1 year, but less than 3 years
More than 3 years, but less than 5 years
More than 5 years

04

Which of the following qualifications do you have? I do not have this experience.
Experience and knowledge in the Provider One system (MMIS) and systems such as Document Management Systems.
Barcode and ACES, knowledge of medical terminology, Washington Administrative Codes related to prior authorizations and Agency administered programs, and Health Care Authority Medicaid Billing Instructions.
Ability to use multiple software applications, e.g. Microsoft Word, Microsoft Excel, Microsoft Access, and Outlook

05

If hired for this position, do you currently possess required documents to allow you to legally work within the United States? The attached link lists acceptable documents: https://www.uscis.gov/i-9-central/form-i-9-acceptable-documents Yes
No

06

Will you now or in the future require sponsorship for an immigration-related employment benefit?For purposes of this question "sponsorship for an immigration-related employment benefit" means "an H-1B visa petition, an O-1 visa petition, an E-3 visa petition, TN status and 'job flexibility benefits' (also known as I-140 portability or Adjustment of Status portability) for long-delayed adjustment of status applications that have been pending for 180 days or longer." (Please contact us at the email address on the bottom of this job posting if you are uncertain whether you may need immigration sponsorship or desire clarification.) Yes
No

Required Question