State of Washington

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Medical Assistance Program Specialist 3 (MAPS 3/MPOI)

at State of Washington

Posted: 11/18/2019
Job Status: Full Time
Job Reference #: 2372818
Keywords: professional

Job Description

Overall Job Objective


Medical Assistance Program Specialist 3  (MAPS 3/MPOI)

We are seeking an energetic self-motivated individual with system and program development experience.  This person must have an understanding of how current Medicaid processes work including, federal waiver programs, the State Plan, benefits, specialized populations, enrollment, encounters, appeals and denials. If you are flexible, dedicated, have great customer service skills, and think outside the box, this opportunity may be for you!
Position Objective:
This position is a subject matter expert on medical assistance programs, with an extensive knowledge of managed care delivery systems, Medicaid and Medicare benefits, Federal rules and regulations, and the ProviderOne payment and enrollment Medicaid Management Information System. 
This position supports the design and implementation of new projects that serve complex populations, for example, Integrated Managed Care, Health Homes, and Accountable Health Communities. This position may also be involved in the design and development for other new initiatives, federal waivers, grants, reports, or contracts.

Some of what you will do:
Identification of common issues and barriers to delivery of services under the new managed care integrated delivery system.
Development of talking points, FAQ's and other materials in response to issues identified by providers, stakeholders, and staff.
Serves as the primary contact and subject matter expert providing one-on-one technical assistance for providers, stakeholders, and staff to support managed care integration and other new programs as needed.
Serves as the subject matter expert and primary contact for managing allocation of clients at state institutions at start-up of new integrated region.
Engaging in communication with institutional setting staff in preparation for transition to FIMC.
Subject matter expert responsible for researching appropriate Recipient Aid Categories (RACs) to ensure eligible populations are included for automated enrollment.
Subject matter expert responsible for researching individual beneficiary issues with enrollment post-implementation of program changes.
Subject matter expert responsible for trouble shooting and fixing complex beneficiary enrollment issues.
Identifying less than optimal beneficiary design elements and applying problem solving skills to promote improvement.
Training customer service staff on operational aspects of new programs.
Subject matter expert responsible for ensuring appropriate managed care enrollment for groups of clients with complex needs, such as clients in residential and institutional settings.
            Development of databases and development of testing scenarios to ensure testing environment.
            Reviewing testing results to identify problems in new programming, including facilitation with data system staff to correct errors.
Provides consultative expertise regarding medical assistance programs, eligilbity, and processes to management in support of integration efforts.
Performing targeted research on provider networks as a result of inquiries from within and outside the agency in response to questions.
Working with the Network Administrator and other program staff to perform Network Adequacy and Access to Care Audits for monitoring purposes.
Developing documentation and methodology for analyzing provider networks in support of behavioral health integration and other new programs as required.
Preparing issue papers, reports, FAQ's and presentations on collective and individual plan network development for internal and external stakeholders.
Providing business justifications, needs, impacts, and design changes for system change requests.
Working directly with data system staff to articulate and design new automated processes for enrollment and payment.
Engage in discussions with stakeholders.
Participate in rate setting sessions with actuaries and review rate setting data books.
Write, edit and review contracts, procurement documents, and grant language.
Review and analysis of federal and state authority and regulations for existing and new initiatives.
Conduct impact analysis linking new programs to operation considerations (transportation, interpreter services, point of sale –pharmacy, and other programs within HCA and other state agencies).
The development of policies, procedures, and analysis of federal or state legislation.
Write, edit and review contracts, procurement documents, and grant language.
Review and analysis of federal and state authority and regulations for existing and new initiatives.
Here is what we are looking for (Required Qualifications):
One year as a Medical Assistance Program Specialist 1
One year as a Medical Assistance Specialist 5
Two years as a Medical Assistance Specialist 4
Desirable/Preferred Qualifications:

A Bachelor's degree from an accredited college with a major study in public health, public administration, business administration, social work or closely related field. (Two additional years of qualifying experience will substitute for the required Bachelor's degree provided an Associate's degree from an accredited college has been achieved)

Three years supervisory or consultative experience in health services, social service, Medicare programs, Medicaid programs or social security disability programs.

Experience working in Medicaid, Medicare or commercial insurance program managing complex health care programs for specialized populations. 

Project management experience.

Presentation and written communication experience.

About the HCA:
The Washington State Health Care Authority (HCA) purchases health care for more than 2 million Washington residents through Apple Health (Medicaid), the Public Employees Benefits Board (PEBB) Program, and, beginning in 2020, the School Employees Benefits Board (SEBB) Program. Our agency is committed to whole person care, integrating physical health and behavioral health services for better results and healthier residents. 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.
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 and attach:
  • A cover letter that specifically addresses how you meet the qualifications for this position.
  • Current resume
  • Three professional references
If you have questions about the process, or need reasonable accommodation, please contact the recruiter before the posting closes. The candidate pool certified for this recruitment may be used to fill future similar vacancies for up to the next six months.
Washington State is an equal opportunity employer. Persons with disabilities needing assistance in the application process, or those needing this job announcement in an alternative format may call the Human Resources Office at 360.725.1761 or email
*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 but will be considered in determining the applicant's suitability and competence to perform in the position. *