[Hiring] Health Insurance Specialist @State of Washington

Role Description

This position investigates and researches cases of Medicaid billing to determine whether third party liability coverage should have been used. The goal of this work is to ensure that Medicaid has been the payer of last resort, to ensure proper use of these public funds. This work requires delving into situations to find new information and wade through ambiguity with a goal of ensuring medical costs being covered by the correct entities. If you are a problem solver who likes to ask questions and dig deep to uncover issues or explore curiosities, 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 resides in the Health Insurance Unit (HIU) within the Coordination of Benefits and Claims Office (COBCO) and supports HCA’s vision for a healthier Washington via both health purchasing strategies as well as customer-centered service. This position investigates and verifies potential third party liability (TPL) coverage leads and integrates third party liability coverage into the ProviderOne MMIS, to ensure cost avoidance or cost recovery of Medicaid expenditures, assuring Medicaid will be the payer of last resort.

• Independently provide expert consultative services to providers and clients, both orally and in writing, concerning coordination of TPL and Medicaid benefits.
• 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 is within the State of Washington. This position reports to Olympia, WA.
• Frequency of onsite work will vary based on business and operational needs.
• All agency employees are required to report on-site in Olympia on their first and last days of employment to pick up and return state-issued equipment, regardless of telework status or location.

Qualifications

• Qualifying candidates will meet one of the following criteria options:
• Option 1: Bachelor’s degree and one year of the experience defined below.
• Option 2: Associate degree and three years of the experience defined below.
• Option 3: Certificate of Medical Billing and Coding, or a closely related certificate program, and three years of the experience defined below.
• Option 4: Five years of the experience defined below.
• Option 5: One year as a Medical Assistance Specialist 2.
• Qualifying experience is defined as:
• 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.
• 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.
• Required competencies:
• The ability to take action to learn and grow.
• The ability to take action to meet the needs of others.

Requirements

• Demonstrated experience with:
• Communicating with external parties to acquire or understand complex information.
• Navigating web sites and online resources to perform research and make decisions.
• Writing correspondence on complex topics in a way that makes concepts clear to the recipient.
• Navigating complex problems for which there may be incomplete information or context.
• Medicaid and/or private health insurance.
• ProviderOne, Barcode, Service Now (SNOW), and ACES Online.
• Microsoft products (Outlook, OneNote, Excel, Teams, Word, etc).
• Strong oral and written communication skills while providing excellent customer service.
• Resolving complex complaints, problems, and conflicts with clients, providers and insurance companies.
• Critical thinking skills; use good judgment in evaluating situations and making decisions.
• Self-motivation and working independently.
• Knowledge of:
• Medical terminology, anatomy, procedure and diagnosis codes.
• Medical billing and insurance claim processes.
• Demonstrated ability to:
• Understand and apply procedures, policies, and guidelines.
• Learn new and/or increasingly complex duties.
• Accept accountability for actions; use feedback to improve.
• Navigate comfortably when using technology (Outlook, Word, Excel, web navigation).

Benefits

• Meaningful work with friendly co-workers who care about those we serve.
• A clear agency mission that drives our work and is person-centered.
• A healthy work/life balance, including alternative/flexible schedules and mobile work options.
• A great total compensation and benefit package.
• A safe, pleasant workplace in a convenient location with restaurants and shopping nearby.
• Free parking!