Medical Assistance Specialist 3 Location: Grant County United States Job Description: Medical Assistance Specialist 3 (MAS3/AHSO) - Moses Lake 71036577 This position is based out of the Moses Lake Community Health Center in Moses Lake, WA. This position is required to obtain Spanish dual language certification within 30 days of employment. As a result, the successful candidate will also receive 5% assignment pay on top of their base salary. This position works a hybrid schedule based out of the Moses Lake Community Health Center to determine individual and family eligibility for Washington State medical assistance programs. Within the Apple Health Services and Operations (AHSO) Division, this position supports the Health Care Authority (HCA) mission to provide access to medical care for all eligible Washington citizens. 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. About the division: The Apple Health Services and Operations (AHSO) Division works across the Health Care Authority (HCA) and in partnership with the health care community at local, state and federal levels, in order to develop, and manage high quality, and evidence-based health care programs and purchase services that enhance Washington State's citizens' ability to access appropriate, quality health care. About the position: This position supports the HCA mission to provide access to medical care for all eligible Washington citizens. The position determines initial eligibility and/or ongoing individual and family medical eligibility for Medicaid Title XIX, Children's Health Insurance Program (CHIP) Title XXI program, and other Medicaid and state funded medical assistance programs available in Washington State. This position is eligible to telework but is typically required to report on-site four days per week in the Moses Lake Community Health Center. This expectation may increase or decrease depending on the facility's needs.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. This position reports to Moses Lake, WA. Frequency of onsite work will vary based on business and operational needs. HCA has currently suspended the ability to support out-of-state telework. Some of what you will do: - Independently determine initial and/or ongoing eligibility for Health Care Authority Medicaid Title XIX, CHIP Title XXI, and other Medicaid and state funded medical assistance programs administered by the MEDS office. - Apply complex federal and state eligibility regulations published in WAC and RCW to specific household circumstances resulting in accurate eligibility decisions. - Use and manage multiple interdependent electronic systems including Automated Client Eligibility System (ACES), HealthPlanFinder, ProviderOne, Audit Plus, Microsoft Office, SOLQ, Document Management System (DMS), and Employment Security Department (ESD). - Analyze, research, and resolve complex eligibility issues applying proper rules and procedures with a high degree of independence. - Conduct interviews over the telephone, in person, and/or through written correspondence with clients, providers and/or third parties to obtain information for required documentation and verification to support program eligibility. Establish effective working relationships with clients and their advocates and manage difficult interactions with tact and diplomacy. - Work with individual Take Charge providers to answer inquiries and resolve issues related to eligibility for the Take Charge Family Planning program. - Provide all essential functions to customers 90% of the time speaking and writing Spanish. - Answer inquiries, resolve questions, update eligibility records and otherwise maintain and expand access to medical care for eligible Washington citizens. Required qualifications: Qualifying candidates will meet one of the following criteria options: Option 1: - Bachelor's degree and - One year of the qualifying experience as defined below. Option 2: - Associate degree and - Three years of the qualifying experience as defined below. Option 3: - Completion of a Certificate of Medical Billing and Coding, or closely related certificate program and - Three years of the qualifying experience as defined below. Option 4: - Five years of the qualifying experience as defined below. Option 5: - One year as a Medical Assistance Specialist 2. Qualifying experience for this position 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; 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. Required competencies: - The ability to take action to learn and grow. - The ability to take action to meet the needs of others. - Must be proficient in written and oral English and demonstrate proficiency in speaking and writing in Spanish. Incumbents will be required to be tested and pass the appropriate language skills test(s) as administered by the Department of Social and Health Services Language Testing and Certification (LTC) program within 30 days of employment. Preferred qualifications: - Experience performing conflict resolution with customers. - Knowledge of Medicaid programs and eligibility. - Experience utilizing Microsoft Office programs such as Outlook, Word, and SharePoint. 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 in separate files: - 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. About HCA: Functioning as both the state's largest health care purchaser and its behavioral health authority, the Washington State Health Care Authority (HCA) is a leader in ensuring Washington residents have the opportunity to be as healthy as possible. There are three pillars of our work: Apple Health (Medicaid); the Public Employees Benefits Board (PEBB) and School Employees Benefits Board (SEBB) programs; and behavioral health and recovery. Under these pillars, HCA purchases health care, including behavioral health treatment for more than 2.7 million Washington residents and provides behavioral health prevention, crisis, and recovery supports to all Washington residents. 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. - 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, and persons of disability are less likely to apply for jobs unless they feel they meet every qualification as described in a job description. Persons over 40 years of age, disabled and Vietnam era veterans, as well as people of all sexual orientations and gender identities are also encouraged to apply. 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 jake.nelko@hca.wa.gov or 360.725.0945. 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. 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Job Description: Sharecare is a digital healthcare company that delivers software and tech-enabled services to stakeholders across the healthcare ecosystem to help improve care quality, drive better outcomes, and lower costs. Through its data-driven AI insights, evidence-based resources, and comprehensive platform – including benefits navigation, care management, home care resources, health information management, and more – Sharecare helps people easily and efficiently manage their healthcare and improve their well-being. Across its three business channels, Sharecare enables health plan sponsors, health systems and physician practices, and leading pharmaceutical brands to drive personalized and value-based care at scale. To learn more, visit www.sharecare.com. Shift: - Night Shift: Monday-Friday 11p-7:30a EDT Job Summary: This position is responsible for processing all release of information (ROI) requests in a timely and efficient manner while delivering exceptional customer service. The Associate must safeguard patient privacy at all times by ensuring that only authorized individuals have access to medical records and that all information is released in accordance with the request, applicable authorization, company policies, and HIPAA regulations. Essential Functions: - Processes ROI requests from facilities timely, accurately, and in accordance with established procedures and quality standards. - Validates requests and authorizations for medical record releases based on company policy and legal guidelines. - Performs quality checks on all work to assure accuracy, confidentiality, and correct billing of all released records. - Maintains equipment in excellent working condition. - Delivers outstanding customer service by being attentive, respectful, and responsive to client needs proactively identifying and resolving concerns. - Maintains a clean, professional appearance and complies with dress code standards. - Maintains up-to-date knowledge of applicable state laws and fee structures. - Works within assigned scope and is flexible in accepting additional assignments or account coverage during backlogs. - Complies with client site policies and procedures, including HIPAA, state and federal regulations, and labor laws. - Handles confidential information with integrity and professionalism while ensuring efficient, accurate record release. Qualifications: - High School Diploma or GED required - Minimum of 2 years' ROI fulfillment experience with Sharecare HDS or 3 years' of external ROI experience required - Advanced knowledge of multiple EMR platforms and ROI request types - Strong documentation, communication, and customer service skills - Proficiency in Microsoft Office applications - Strong organizational and multitasking skills essential - Willingness to learn programs and processes quickly - Self-motivated, dependable, and able to work independently or as part of a team - Proven ability to maintain productivity, utilization, and quality performance standards - Strong interpersonal and problem-solving skills Physical Requirements: - Ability to sit or stand for extended periods - Physical capacity to lift and carry up to 25 lbs. - Manual dexterity is sufficient for long periods of typing, writing, and handling documents - Visual acuity to read documents and use a computer monitor - Clear speaking and hearing ability for effective communication - Adequate hand-eye coordination and sensory abilities for job-related tasks Information Governance Accountabilities: - Understand the organization's information governance program and associated responsibilities - Participate in compliance education and role-specific training HIPAA/ Compliance: - Maintain the confidentiality of patient and client information - Comply with HIPAA standards and all relevant corporate integrity and security obligations - Report unethical, fraudulent, or unlawful behavior or activity - Maintain current HIPAA certification annually Sharecare and its subsidiaries are Equal Opportunity Employers and E-Verify users. Qualified applicants will receive consideration for employment without regard to race, color, sex, national origin, sexual orientation, gender identity, religion, age, equal pay, disability, genetic information, protected veteran status, or other status protected under applicable law.

We take great strides to ensure our employees have the resources to live well, be healthy, continue learning, develop skills, grow professionally and serve our local communities. We invite you to apply for a career with Blue Cross. Residency in or relocation to Louisiana is preferred for all positions. POSITION PURPOSE The Behavioral Health Utilization Reviewer is responsible for conducting clinical reviews of behavioral health service requests, claims, and appeals to confirm medical necessity and appropriateness of care. The reviewer applies evidence-based criteria including InterQual and/or medical policy and collaborates with the Behavioral Health Medical Director for complex cases and requests that do not meet criteria for approval. This role does not make adverse determinations based on medical necessity. This role also involves gathering information from and communicating decisions to providers and members in a clear, timely, and professional manner. How You Contribute to the Company’s Mission In This Role - Review pre-authorization requests, concurrent reviews, and retrospective claims for behavioral health services. - Apply clinical guidelines (e.g., InterQual, medical policy) to document medical necessity. - Refer cases that do not meet criteria to the Psychiatric Medical Director for secondary review. - Review and support the appeals department in reviewing provider and member appeals in accordance with regulatory timelines. - Interacts with BH care providers as necessary to discuss level of care and/or service decisions. - Document clinical decisions and rationale in the utilization management system. - Communicate determinations to providers and members via phone and written correspondence. - Analyze BH member data to improve quality and appropriate utilization of services - Collaborate with internal departments including Case Management, Quality, and Provider Relations. - Maintain compliance with state, federal, and accreditation requirements (e.g., CMS, NCQA, URAC). - Participate in audits, training, and quality improvement initiatives. Required Qualifications - Bachelor’s degree in nursing, healthcare, or a related field OR master’s degree in social work, counseling, or behavioral health - RN license in Louisiana can OR LPN license in Louisiana + 2 years of related experience can replace the bachelor’s degree - At least 3 years of clinical or patient care experience in behavioral health - Must have one of the following: LPC, PLPC, LCSW, LMFT, LMSW, LPN, or RN - Strong clinical assessment and critical thinking - Excellent communication and teamwork - Good understanding of behavioral health conditions and treatments - Able to work independently and follow policies Preferred Qualifications - Experience in a managed care or health insurance setting - Familiarity with CPT codes and billing practices. - Experience working with Medicare and Commercial populations - Proficiency in electronic health records and case management systems The Physical Demands described here are representative of those that must be met by an employee to successfully perform the Accountabilities and Essential Functions of the job. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential functions - Perform other job-related duties as assigned, within your scope of responsibilities. - Job duties are performed in a normal and clean office environment with normal noise levels. - Work is predominately done while standing or sitting. - The ability to comprehend, document, calculate, visualize, and analyze are required. An Equal Opportunity Employer All BCBSLA EMPLOYEES please apply through Workday Careers. PLEASE USE A WEB BROWSER OTHER THAN INTERNET EXPLORER IF YOU ENCOUNTER ISSUES (CHROME, FIREFOX, SAFARI) Additional Information Please be sure to monitor your email frequently for communications you may receive during the recruiting process. Due to the high volume of applications we receive, only those most qualified will be contacted. To monitor the status of your application, please visit the "My Applications" section in the Candidate Home section of your Workday account. If you are an individual with a disability and require a reasonable accommodation to complete an application, please contact recruiting@bcbsla.com for assistance. In support of our mission to improve the health and lives of Louisianians, Blue Cross encourages the good health of its employees and visitors. We want to ensure that our employees have a work environment that will optimize personal health and well-being. Due to the acknowledged hazards from exposure to environmental tobacco smoke, and in order to promote good health, our company properties are smoke and tobacco free. Blue Cross and Blue Shield of Louisiana performs background and pre-employment drug screening after an offer has been extended and prior to hire for all positions. As part of this process records may be verified and information checked with agencies including but not limited to the Social Security Administration, criminal courts, federal, state, and county repositories of criminal records, Department of Motor Vehicles and credit bureaus. Pursuant with sec 1033 of the Violent Crime Control and Law Enforcement Act of 1994, individuals who have been convicted of a felony crime involving dishonesty or breach of trust are prohibited from working in the insurance industry unless they obtain written consent from their state insurance commissioner. Additionally, Blue Cross and Blue Shield of Louisiana is a Drug Free Workplace. A pre-employment drug screen will be required and any offer is contingent upon satisfactory drug testing results.

ABC Story: Our story began in 2017 in Austin, TX. We started with humble roots but big aspirations. From 1 center in North Austin, our movement has inspired thousands of clinicians and operators. Today, the ABC community is 10,000+ strong serving thousands of children with ASD. Growth with intentionality: We have an intentional focus on our core values. Each center is purpose-built, and each community of teammates is nurtured. Summary: We are looking for an assertive and driven clinical professional to join our team in a crucial administrative role to help our ABA Therapy organization grow! Action Behavior Centers is a leading development organization for children with autism based out of Austin, Texas. With numerous clinics opening up across the United States, we need someone who shares our vision for expansion and wants to help take us there. Our Corporate Team needs someone passionate about helping kiddos with autism get the therapy they need. This role will support the Vice President of Clinical Services, the Director of Clinical Advocacy and Authorizations, and the Regional Autism Advocate(s) with time-sensitive documentation fidelity and discuss clinical needs with insurance companies. The ideal candidate will be a RBT having worked in the field with various demographics of children impacted with Autism and has a hunger for continued growth in knowledge of ABA & Autism services, OR a Registered Behavior Technician (RBT) completing their Master’s Program to become a Board Certified Behavior Analyst (BCBA) with only indirect hours left to be able to sit for the Behavior Analyst Certification Board (BACB) Exam to become a BCBA would be ideal. Requirements: - Familiarity with SalesForce is recommended but not required - Registered Behavior Technician (RBT) required; An RBT with 2+ years of clinical experience is preferred - Working knowledge and understanding of Applied Behavior Analysis (ABA) therapy is strongly recommended - Previous experience negotiating with insurance companies - A strong, pleasant personality with a high EQ - Extremely detail oriented – you minimize mistakes because you care about how your work affects patients - Assertive and strong communication style - you know how to get what you want because you can eloquently present the facts and advocate for patient services - You possess a high-level of organizational skills - you rarely drop the ball because you love having systems in place to keep things running smoothly - You like to work really hard – you aren’t watching the clock for quittin’ time because there is always more than needs to be done, and you like that - Undergraduate is ideal but not required Responsibilities: - Assisting Regional Autism Advocate(s) in campaigning to insurance companies on patient services - Review and confirm patient intake paperwork - Review & proof read patient reports provided by BCBAs and prepare patient documents for insurance authorization requirements - Manage & upkeep patient paperwork in SalesForce - Participate in meetings with the Corporate Team - Maintain patient communication with the Office Managers across all ABC locations - Assist Regional Autism Advocate(s) and Director of Clinical Advocacy and Authorizations with Ad Hoc projects. This may also be inclusive of Ad Hoc projects from our Vice President of Clinical Services. - Oversees and maintains the company's healthcare data entry procedures within HIPAA compliance guidelines. - Confirm authorization via phone calls, and enter authorization documents quickly and accurately. - Confirm, maintain and enter patient's healthcare and authorization information with sensitivity and discretion into the EMR/billing system. - Fax and submit for authorization of treatment. - Schedule Peer-to-Peer (P2P) calls for insurance companies; This includes scheduling P2P calls for our BCBAs regarding general or specific clinical case discussions, etc. - Account for submission and resubmission to new insurance companies with updated paperwork Perks: - 10 Days of PTO, 10 Paid Holidays, 2 Flex Days + More with Tenure - Student Loan Repayment Employer Contributions - Maternity/Paternity Award of up to $3,000 & FSA Options for Childcare - Door Dash Pass and Regional Night of Honors - Up to $600 Student Loan Repayment Options & Tuition Discounts Additional Rewards: - Professional development: we want to pour into you as you pour into ABC - Leadership opportunities: To be the best, we have to continually keep learning and you get to push yourself here to learn more and take on more responsibilities, and show what you can do! - 401K Retirement Plans with company matching Our Community & Culture - Instagram: https://instagram.com/actionbehaviorcenters - Facebook: https://facebook.com/actionbehaviorcenters See what others have said when they made the decision to grow with us! Glassdoor LinkedIn ABC is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, age, religion, sex, sexual orientation, gender identity or expression, national origin, ancestry, disability, marital status, genetic information, veteran status, or any other status protected by applicable federal, state, or local laws, including the Pennsylvania Human Relations Act (PHRA). We are committed to creating an inclusive environment for all employees. @Copyright 2026