Washington State Medical Assistance Specialist 3 (ASO) in Olympia, Washington

Description

The Clinical Quality and Care Transformation division is seeking a customer service professional with direct client services or counseling experience and preferably with pharmaceutical experience to fill the position of Medical Assistance Specialist 3. The ideal candidate will be a reliable, consistent, and collaborative team player.

About the Position: This is a journey-level position that provides expert consultative service to providers when processing Prior Authorization (PA) requests for pharmaceuticals for Medicaid clients. Prior authorization requests are received from Physicians and Pharmacies by telephone and fax and are adjudicated or sent for clinical review within the required WAC time frames for approval, denial, or pending for further review. The incumbent work on a primarily independent basis with training and guidance from a lead worker.

About the agency: The Health Care Authority (HCA) is Washington State's largest health care purchaser – public or private. Both as an employer covering nearly 370,000 lives, and the state's Medicaid agency, covering nearly 1.9 million Washingtonians, HCA provides health care access for more than one-third of the state's nonelderly population, more than 2 million people. HCA is a leader in moving health care forward both in Washington State and nationwide. The Washington State Health Care Authority purchases health care for more than 2 million Washington residents.

Some duties of this position:

  • Adjudicates prior authorization requests for pharmaceuticals at the first level of review based on established policy and procedures in accordance with state and federal law.
  • Independently reviews and evaluates Prior Authorization requests for appropriateness, deviation from established medical standards/policies, medical contraindications, and medical necessity.
  • Requests additional medical information from prescribing physicians to adjudicate the prior authorization request or forward to clinical staff for second level review.
  • Completes documentation of disposition and notifies the pharmacy, physician, and client as appropriate of the prior authorization decision.
  • Identifies current drug utilization specific to client and prescribers, educational information to be added to Health Care Authority internet, and reviews and resolves complex/complicated requests.
  • Screens requests for compliance with documentation/justification and criteria. Refers more complex problems to clinical pharmacists.

Required Education and Experience: Bachelor's degree and one year of experience providing direct client services or counseling of customers in the areas of health insurance, disability, or related health benefits; public assistance eligibility determination; health insurance premiums/claims processing, adjusting, and investigations; or other medical premiums/claims related experience. Or One year as a Medical Assistance Specialist 2. Experience providing direct client services or counseling of customers in the area 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 will substitute year for year, for education.

Preferred/Desired Qualifications: Knowledge of: State and Federal regulations and departmental rules; medical terminology and pharmaceuticals; standards of medical treatment and practice; Point of Sale system.

How to Apply: Only candidates who reflect the minimum qualifications on their State application 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
  • 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 360.725.1180 or emailSanyu.Tushabe@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. *

Salary: $35,808.00 - $46,596.00 Annually

Location: Thurston County – Olympia, WA

Job Type: Full Time - Permanent

Department: Health Care Authority

Job Number: 2018-03887

Closing: 4/24/2018 11:59 PM Pacific

Agency: State of Washington

Address: View Job Posting for Agency Information View Job Posting for Location, Washington, 98504

Phone: View Posting for Agency Contact

Website: http://www.careers.wa.gov