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Posted : Wednesday, November 15, 2023 02:15 AM
Description
Health Benefits Specialist 3 (MAS3/MCS/Call Center)
This recruitment may be used to fill multiple positions.
This position works in a customer service and call center environment to explain medical benefit scope of care, enroll Washington Apple Health (Medicaid) clients into managed care plans, resolve procedural problems involving clients, insurance carriers, or providers, and research to resolve complex inquiries regarding claims, problems, and conflicts in the Medical Assistance Customer Service Center (MACSC).
If you enjoy providing excellent customer service via phone, learn quickly, and demonstrate strong problem-solving skills, this may be the position for you.
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.
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: Provides expert consultation to clients, providers, Managed Care Organizations (MCO), local community service offices (CSO), and stakeholders regarding benefits and services provided by the Apple Health (Medicaid) program, and other state programs via toll-free lines and written correspondence.
Counsels and advises customers on Health Care Authority (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, local community services offices, 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, 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.
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.
Utilizes excellent written and oral communication skills, applies effective customer service techniques and principles, and maintains a thorough knowledge of ProviderOne (P1), Point-Of-Sale pharmacy claims processing system (POS), Automated Client Eligibility System (ACES), Treasury Management System (TMS), Siebel Contact Management System and Siebel soft phone, State and Federal Title XIX policy, managed care programs, HealthPlanfinder application (Health Benefit Exchange System), and medical terminology.
Qualifications Required qualifications: Qualified candidates will meet one of the following criteria: Bachelor’s degree AND one year of the experience as defined below, OR Associate degree AND three years of the experience as defined below, OR Certificate of Medical Billing and Coding or closely related certificate program AND three years of the experience as defined below, OR Five years of the experience as defined below The experience required is one 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; other medical premiums/claims/eligibility related experience; or experience researching and analyzing complex rules, regulations, or policies and utilizing research and analysis to make determinations, solve problems, or complete work while providing direct customer service either in person or on the telephone.
Preferred qualifications: Computer skills, knowledge of ACES, P1, Siebel, and knowledge of Medicaid programs.
Ability to consistently provide excellent customer service during a full shift of continuous phone calls within a toll-free customer service center.
Ability to manage information arising out of conflicting rules and procedures that are established by other sections.
Ability to manage stress arising out of diverse conflicts and the demands of customers to provide the correct resolution of issues within a short period of time.
Ability to counsel and placate customers’ expectations when they are different from the policy and regulations under Washington Administrative Code.
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 the HCA: The Washington State Health Care Authority (HCA) is committed to whole-person care, integrating physical health and behavioral health services for better results and healthier residents.
HCA purchases health care for more than 2.
5 million Washington residents through Apple Health (Medicaid), the Public Employees Benefits Board (PEBB) Program, and the School Employees Benefits Board (SEBB) Program.
As the largest health care purchaser in the state, we lead the effort to transform health care, helping ensure Washington residents have access to better health and better care at a lower cost.
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.
Studies have shown 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 less likely to apply for jobs unless they feel they meet every qualification as described in a job description.
If you have any questions about the required qualifications or how your experience relates to them, please contact us at HCAjobs@hca.
wa.
gov.
Persons with disabilities needing assistance in the application process, or those needing this job announcement in an alternative format may contact Jake Nelko at 360-725-0945 or jake.
nelko@hca.
wa.
gov.
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.
Subscribe to our weekly newsletter to receive a list of new job postings at HCA.
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 BenefitsEmployees 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 CompensationState 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 SecurityAll 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 ForgivenessIf 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 WAC 357-31-165(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 WAC 357-31-165(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 WAC 357-58-175, 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 LeaveWashington 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 LeaveLeave SharingParental LeaveFamily and Medical Leave Act (FMLA)Leave Without PayPlease visit the State HR Website for more detailed information regarding benefits.
Updated 12-31-2022
This position works in a customer service and call center environment to explain medical benefit scope of care, enroll Washington Apple Health (Medicaid) clients into managed care plans, resolve procedural problems involving clients, insurance carriers, or providers, and research to resolve complex inquiries regarding claims, problems, and conflicts in the Medical Assistance Customer Service Center (MACSC).
If you enjoy providing excellent customer service via phone, learn quickly, and demonstrate strong problem-solving skills, this may be the position for you.
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.
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: Provides expert consultation to clients, providers, Managed Care Organizations (MCO), local community service offices (CSO), and stakeholders regarding benefits and services provided by the Apple Health (Medicaid) program, and other state programs via toll-free lines and written correspondence.
Counsels and advises customers on Health Care Authority (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, local community services offices, 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, 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.
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.
Utilizes excellent written and oral communication skills, applies effective customer service techniques and principles, and maintains a thorough knowledge of ProviderOne (P1), Point-Of-Sale pharmacy claims processing system (POS), Automated Client Eligibility System (ACES), Treasury Management System (TMS), Siebel Contact Management System and Siebel soft phone, State and Federal Title XIX policy, managed care programs, HealthPlanfinder application (Health Benefit Exchange System), and medical terminology.
Qualifications Required qualifications: Qualified candidates will meet one of the following criteria: Bachelor’s degree AND one year of the experience as defined below, OR Associate degree AND three years of the experience as defined below, OR Certificate of Medical Billing and Coding or closely related certificate program AND three years of the experience as defined below, OR Five years of the experience as defined below The experience required is one 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; other medical premiums/claims/eligibility related experience; or experience researching and analyzing complex rules, regulations, or policies and utilizing research and analysis to make determinations, solve problems, or complete work while providing direct customer service either in person or on the telephone.
Preferred qualifications: Computer skills, knowledge of ACES, P1, Siebel, and knowledge of Medicaid programs.
Ability to consistently provide excellent customer service during a full shift of continuous phone calls within a toll-free customer service center.
Ability to manage information arising out of conflicting rules and procedures that are established by other sections.
Ability to manage stress arising out of diverse conflicts and the demands of customers to provide the correct resolution of issues within a short period of time.
Ability to counsel and placate customers’ expectations when they are different from the policy and regulations under Washington Administrative Code.
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 the HCA: The Washington State Health Care Authority (HCA) is committed to whole-person care, integrating physical health and behavioral health services for better results and healthier residents.
HCA purchases health care for more than 2.
5 million Washington residents through Apple Health (Medicaid), the Public Employees Benefits Board (PEBB) Program, and the School Employees Benefits Board (SEBB) Program.
As the largest health care purchaser in the state, we lead the effort to transform health care, helping ensure Washington residents have access to better health and better care at a lower cost.
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.
Studies have shown 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 less likely to apply for jobs unless they feel they meet every qualification as described in a job description.
If you have any questions about the required qualifications or how your experience relates to them, please contact us at HCAjobs@hca.
wa.
gov.
Persons with disabilities needing assistance in the application process, or those needing this job announcement in an alternative format may contact Jake Nelko at 360-725-0945 or jake.
nelko@hca.
wa.
gov.
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.
Subscribe to our weekly newsletter to receive a list of new job postings at HCA.
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 BenefitsEmployees 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 CompensationState 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 SecurityAll 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 ForgivenessIf 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 WAC 357-31-165(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 WAC 357-31-165(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 WAC 357-58-175, 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 LeaveWashington 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 LeaveLeave SharingParental LeaveFamily and Medical Leave Act (FMLA)Leave Without PayPlease visit the State HR Website for more detailed information regarding benefits.
Updated 12-31-2022
• Phone : (360) 725-0945
• Location : Olympia, WA
• Post ID: 9140734707
