Medical Authorization Specialist

Medical Authorization Specialist (MAS3/CQCT)
Location: Olympia United States

Salary

$48,048.00 - $64,512.00 Annually

Location

Thurston County - Olympia, WA

Job Type

Full Time - Permanent

Remote Employment

Remote Optional

Job Number

2026-05806

Department

Health Care Authority

Division

CQCT

Job Description:

Medical Authorization Specialist (MAS3/CQCT)

71114629

This recruitment will be used to fill multiple positions.

The Medical Authorization Specialist (Medical Assistance Specialist 3) provides expert consultative services to providers and clients within the prior authorization process, helping ensure that requested procedures, tests, and medications meet evidence-based clinical guidelines. The position involves high-volume caseload work with an emphasis on accuracy, timelines, WA Administrative Codes (WACs) and ProviderOne systems. Fully-telework eligible and based in Olympia, this role is a strong fit for someone with a background in health care office settings, insurance claim processing, or public assistance eligibility determination.

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 Clinical Quality and Care Transformation (CQCT) Division is responsible for designing and implementing clinical policy and conducting oversight and monitoring of clinically related activities. CQCT partners with tribes, stakeholders, providers, plans, delivery systems, and others on state-wide clinical activities and issues. These clinical policies and operations include leading the state in care transformation and supporting HCA programs.

About the position:

This position supports the mission and vision as we work together to provide quality services that enhance our client's ability to obtain and access health care by providing expert consultative services to providers and clients. Prior authorization protects clients from unproven or risky procedures, tests, or medications that may be harmful and do not meet evidence-based guidelines of effective treatment.

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 - both on-site and telework eligible 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.

Duties

Some of what you will do:

• Independently review, analyze, and process incoming complex medical and medical equipment prior authorization requests for validity and compliance with the Medicaid Provider Guides, numbered memorandums, and WACs. Apply complex policies, state and federal rules and regulations.
• Correlates data obtained from sources outside the department to build history on specific clients.
• Evaluate individual complex authorization requests for appropriateness, completeness, compliance with established medical standards, regulations and policies, medical contraindications, and medical necessity. When appropriate, communicate with providers to obtain medical justification for the request.
• Communicate/educate providers to answer questions regarding prior authorization requests and program policy and/or criteria.
• Based on guidelines, independently make approval decisions on complex prior authorization requests and/or route the request to the appropriate clinical staff.
• Determines allowed payment based on manufacturer information and WAC pricing and methodology.
• While processing requests, maintain an acceptable office error rate of less than three percent.
• Independently resolve complex issues related to the multiple complex agency programs. This requires professional communication with providers, clients and other HCA staff 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 senior level consultative services to providers, HCA staff and other state agency staff with respect to multiple agency programs. Maintain workflow for compliance.
• Establish and maintain cooperative and effective relationships with others and demonstrate effective problem-solving techniques when interacting with others
• Review, analyze, and process incoming Alien Emergency Medical (AEM) eligibility requests being submitted to CQCT for review and decisions. Ensure all documentation is received and accurate.
• Communicate across divisions and agency regarding documentation requirements and any questions needing to be problem-solved.
• Based on guidelines, make approval decisions or refer to clinical review.

Qualifications

Required qualifications:

Qualifying candidates will meet one of the following criteria options:

Option 1:

Bachelor's degree in business administration, healthcare administration, Health Information Management, or a related field and one (1) year of experience working in a medical, dental, or other health care office setting making public assistance eligibility determinations; health insurance premiums/claims processing, adjusting, and investigation; or other medical premiums/claims related experience.

Option 2:

Associate degree or Completion of a Certificate of Medical Billing and Coding, and three (3) years of experience working in a medical, dental, or other health care office setting making public assistance eligibility determinations; health insurance premiums/claims processing, adjusting, and investigation; or other medical premiums/claims related experience.

Option 3:

Five years of experience working in a medical, dental, or other health care office setting making public assistance eligibility determinations; health insurance premiums/claims processing, adjusting, and investigation; or other medical premiums/claims related experience.

Option 4:

One (1) year as a Medical Assistance Specialist 2 in State Government possessing the experience listed above.

Required competencies:

• The ability to take action to learn and grow.
• The ability to take action to meet the needs of others.
• Ability to handle high volumes of work.
• Ability to meet timelines.

Preferred qualifications:

• Knowledge of Washington Administrative Codes (WAC) related to prior authorization, Agency administered programs, and the Health Care Authority (HCA) Medicaid Provider Guides.
• Experience and knowledge in the Provider One system (MMIS).
• Ability to use multiple software applications (e.g. Microsoft Word, Excel, Access, and Outlook).

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.

Supplemental Information

About HCA:

Functioning as both the states 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 HCAs 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.

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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More than Just a Paycheck!

Employee benefits are not just about the kind of services you get, they are also about how much you may have to pay out of pocket. Washington State offers one of the most competitive benefits packages in the nation.

We understand that your life revolves around more than just your career. Like everyone, your first priority is ensuring that you and your family will maintain health and financial security. Thats why choice is a key component of our benefits package. We have a selection of health and retirement plans, paid leave, staff training and other compensation benefits that you can mix and match to meet your current and future needs.

Read about our benefits:

The following information describes typical benefits available for full-time employees who are expected to work more than six months. Actual benefits may vary by appointment type or be prorated for other than full-time work (e.g. part-time); view the job posting for benefits details for job types other than full-time.

Note: If the position offers benefits which differ from the following, the job posting should include the specific benefits.

Insurance Benefits

Employees and their families are covered by medical (including vision), dental and basic life insurance. There are multiple medical plans with affordable monthly premiums that offer coverage throughout the state.

Staff are eligible to enroll each year in a medical flexible spending account which enables them to use tax-deferred dollars toward their health care expenses. Employees are also covered by basic life and long-term disability insurance, with the option to purchase additional coverage amounts.

To view premium rates, coverage choice in your area and how to enroll, please visit the Public Employees Benefits Board (PEBB) website. The Washington Wellness program from the Health Care Authority works with PEBB to support our workplace wellness programs.

Dependent care assistance allows the employee to save pre-tax dollars for a child or elder care expenses.

Other insurance coverage for auto, boat, home, and renter insurance is available through payroll deduction.

The Washington State Employee Assistance Program promotes the health and well-being of employees.

Retirement and Deferred Compensation

State Employees are members of the Washington Public Employees Retirement System (PERS). New employees have the option of two employer contributed retirement programs. For additional information, check out the Department of Retirement Systems web site.

Employees also have the ability to participate in the Deferred Compensation Program (DCP). This is a supplemental retirement savings program (similar to an IRA) that allows you control over the amount of pre-tax salary dollars you defer as well as the flexibility to choose between multiple investment options.

Social Security

All state employees are covered by the federal Social Security and Medicare systems. The state and the employee pay an equal amount into the system.

Public Service Loan Forgiveness

If you are employed by a government or not-for-profit organization, and meet the qualifying criteria, you may be eligible to receive student loan forgiveness under the Public Service Loan Forgiveness Program.

Holidays

Full-time and part-time employees are entitled to paid holidays and one paid personal holiday per calendar year.

Note: Employees who are members of certain Unions may be entitled to additional personal leave day(s), please refer to position specific Collective Bargaining Agreements for more information.

Full-time employees who work full monthly schedules qualify for holiday compensation if they are employed before the holiday and are in pay status for at least 80 nonovertime hours during the month of the holiday; or for the entire work shift preceding the holiday.

Part-time employees who are in pay status during the month of the holiday qualify for the holiday on a pro-rata basis. Compensation for holidays (including personal holiday) will be proportionate to the number of hours in pay status in the month to that required for full-time employment, excluding all holiday hours. Pay status includes hours worked and time on paid leave.

Sick Leave

Full-time employees earn eight hours of sick leave per month. Overtime eligible employees who are in pay status for less than 80 hours per month, earn a monthly proportionate to the number of hours in pay status, in the month to that required for full-time employment. Overtime exempt employees who are in pay status for less than 80 hours per month do not earn a monthly accrual of sick leave.

Sick leave accruals for part-time employees will be proportionate to the number of hours in pay status, in the month to that required for full-time employment. Pay status includes hours worked, time on paid leave and paid holiday.

Vacation (Annual Leave)

Full-time employees accrue vacation leave at the rates specified in WAC 357-31-165(1) or the applicable collective bargaining agreement (CBA). Full-time employees who are in pay status for less than 80 nonovertime hours in a month do not earn a monthly accrual of vacation leave.

Part-time employees accrue vacation leave hours in accordance with WAC 357-31-165(1) or the applicable collective bargaining agreement (CBA) on a pro rata basis. Vacation leave accrual will be proportionate to the number of hours in pay status, in the month to that required for full-time employment.

Pay status includes hours worked, time on paid leave and paid holiday.

As provided in WAC 357-58-175, an employer may authorize a lump-sum accrual of vacation leave or accelerate the vacation leave accrual rate to support the recruitment and/or retention of a candidate or employee for a Washington Management Service position. Vacation leave accrual rates may only be accelerated using the rates established WAC 357-31-165.

Note: Most agencies follow the civil service rules covering leave and holidays for exempt employees even though there is no requirement for them to do so. However, agencies are required to adhere to the applicable RCWs pertaining holidays and leave.

Military Leave

Washington State supports members of the armed forces with 21 days paid military leave per year.

Bereavement Leave

Most employees whose family member or household member dies, or for loss of pregnancy, are entitled to five (5) days of paid bereavement leave. In addition, the employer may approve other available leave types for the purpose of bereavement leave.

Additional Leave

Leave Sharing

Parental Leave

Family and Medical Leave Act (FMLA)

Leave Without Pay