State of Washington

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MEDICAL ASSISTANCE SPECIALIST 3 - DENTAL AUTHORIZATION (MAS3/CQCT)

at State of Washington

Posted: 12/6/2019
Job Status: Full Time,Contract/Temporary
Job Reference #: 2604756
Keywords: dental

Job Description

Overall Job Objective

Description


 
Medical Assistance Specialist 3 (MAS3/CQCT)
Dental Authorization

Full-time, Non-Permanent
Olympia, WA
 
Do you have working knowledge of dental terminology or health insurance? Are you able to handle high volumes of work? Do you thrive in a fast paced dynamic environment?

If you are skilled problem solver, and pay attention to detail, this position may be for you!

This job posting 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.

Position Objective:
Prior Authorization protects clients from unproven or risky procedures, tests or medications that may be harmful and do not meet evidence-based guidelines as an effective treatment.  Staff members approve, deny or forward to medical review clinicians:  pharmacy, medical, enteral, dental and DME authorization requests based on medical necessity criteria and best purchasing practices
 
Some of what you will do:
Determines prior authorization of Dental and Orthodontic services
 
  • Review, analyze, and process incoming dental and orthodontic prior authorization requests for validity and compliance with the Medicaid Provider Guides, numbered memorandums, and WACs.  Apply policies, state and federal rules and regulations.
  • Evaluate individual dental requests for appropriateness, completeness, compliance with established dental and medical standards, regulations and policies, dental and medical contraindications, and medical necessity.  When appropriate, communicate with providers to obtain medical justification for the request.
  • Process a minimum of 6.5 requests/hour, while maintaining an acceptable office error rate of less than three percent.
  • Resolve complex issues related to the dental/orthodontic program.  This requires professional communication with providers, clients and other HCA staff in order to resolve complex issues.
  • Notify clients and providers of decisions through clear and concise technical correspondence based on medical necessity of the service requested.  Provide consultative services to providers, HCA staff and other state agency staff with respect to the dental/orthodontic program.  Maintain workflow to and from dental/orthodontic consultants.
  • Establish and maintain cooperative and effective relationships with others, and demonstrate effective problem solving techniques when interacting with others.
 
Daily Tasks
 
  • Navigate and utilize ProviderOne for authorization information,
  • Use MS Word, RightFax, and Outlook,
  • Accurately file denials with hard copy x-rays and photos in alphabetical order,
  • Scan information into ProviderOne using an internal attachment barcode (i.e. translations and return mail),
  • Maintain Excel spreadsheets with accurate and up to date information (i.e. Envelope Log and Outgoing Envelopes to the Dental Consultant),
  • Mail client records to the dental and orthodontic consultants,
  • Look up reference numbers in ProviderOne and label incoming envelopes from providers (may include opening the envelope and verifying the information received),
  • Failed Fax Report, to include sending correspondence through Rightfax or mail, and
  • 25 Report, to include verifying attachment in ProviderOne and noting the Internal Attachments in Excel.
 
Process Improvement and Program Enhancements
 
  • Refer and/or collaborate with Provider Review and Audit Section if specific provider trends are identified where requests seem unusual or inappropriate.
  • Investigate, analyze or resolve, through collaboration with the Provider Relations and Claims Processing regarding claims issues and 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 ongoing program changes to the HCA Provider Guides, numbered memorandums, and Washington Administrative Code (WAC).  Participate in team meetings in order to stay informed of upcoming changes, provide a different perspective, and feedback when appropriate.
  • Establish and maintain cooperative and effective relationships with others, and demonstrate effective problem solving techniques when interacting with others.
 
Required Qualifications:


 
  • Three or more years of working knowledge in dental 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.
  • Ability to handle high volumes of work.
  • Ability to meet timelines.
  • Knowledge of Dental Terminology.
 
Preferred/Desired Qualifications:


 
  • Experience and knowledge in the Provider One system (MMIS).
  • Knowledge of Washington Administrative Codes (WAC) related to prior authorization, Agency administered programs, and the Health Care Authority (HCA) Medicaid Provider Guides.
  • Ability to use multiple software applications (e.g. Microsoft Word, Excel, Access, and Outlook).
 
ABOUT 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.
 
About Olympia and Washington State
Washington State offers a total work/life package of pay, benefits, flexibility, and workplace opportunities to help you get the most out of your career and out of life. Washington State is a great place to work, play, and be a part of a community, offering quality of life that is unsurpassed. From the high energy urban center of Seattle, one of the nation's top ranked cities, to the more relaxed pace of our rural communities, Washington's distinctive Northwest lifestyle blends a progressive, creative culture with a casual nature.
 
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, including a minimum of one past supervisor
If you have questions about the process, or need reasonable accommodation, please contact the recruiter before the posting closes.
  
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 360.549.5442 or email Carolee.Ferrero@hca.wa.gov.
 
*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. *