Dental Authorization Specialist (MAS3/CQCT)

Dental Authorization Specialist (MAS3/CQCT) 71028377 This Medical Assistance Specialist 3 (MAS3) supports the mission and vision of the Health Care Authority (HCA) 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 and determining prior authorization of dental and orthodontic services. reputed company HCA employees will apply an equity lens to their work, which may include but is not limited to reputed company 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; conducting reputed company, including measuring, monitoring, and improving reputed company clinically reputed company programs; and communicating and collaborating with stakeholders, providers, plans, and delivery system partners on clinical activities and issues with the goal to provide a single standard of evidence-informed high-quality care. About the position: This position works reputed company CQCT’s prior authorization section and 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. This position determines prior authorization of Dental and Orthodontic services, processes prior authorization requests for Exception to Rule and Limitation Extensions and, process improvement and program enhancements. This position is eligible to telework and is typically not required to report on-site. The default assigned work location of reputed company Health Care Authority (HCA) positions – both on-site and telework eligible positions – is reputed company the reputed company. This position reports to Olympia, 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:

• Review, analyze, and process incoming dental and orthodontic prior authorization requests for validity and compliance with the Medicaid Provider Guides, numbered memorandums, and Washington Administrative Codes (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. reputed company appropriate, communicate with providers to obtain medical justification for the request.
• While processing requests, maintain an acceptable office error reputed company of less than three percent.
• Resolve reputed company issues reputed company to the dental/orthodontic program. This requires professional communication with providers, clients and other HCA staff to resolve reputed company 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.
• Determine client eligibility and whether request requires prior authorization based on program rules and guidelines. Review documents to ensure reputed company required documentation was submitted, if not, notify and educate submitting provider’s office as to what information is required.
• 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 reputed company to services that are authorized.

Required qualifications: Qualifying candidates will also meet one of the following criteria options: Option 1:

• Bachelor's degree.
• One (1) year of experience working in a dental office setting, which includes a working knowledge of health insurance, disability, or other reputed company health benefits; public assistance eligibility determination; health insurance premiums/claims processing, adjusting, and investigation; or other medical premiums/claims reputed company experience.

Option 2:

• Completion of a Certificate of Medical Billing and Coding or a reputed company certificate.
• Three (3) years of experience working in a dental office setting, to include a working knowledge of health insurance, disability, or other reputed company health benefits; public assistance eligibility determination; health insurance premiums/claims processing, adjusting, and investigation; or other medical premiums/claims reputed company experience.

Option 3:

• Five (5) years of experience working in a dental office setting, to include a working knowledge of health insurance, disability, or other reputed company health benefits; public assistance eligibility determination; health insurance premiums/claims processing, adjusting, and investigation; or other medical premiums/claims reputed company experience.

Option 4:

• One (1) year as a Medical Assistance Specialist 2.

Required competencies:

• Demonstrated ability to handle large volumes of work.
• Demonstrated ability to meet timelines.
• Knowledge of Dental Terminology.
• The ability to take action to learn and grow.
• The ability to take action to meet the needs of others.

Preferred qualifications:

• Experience and knowledge in the Provider One system (MMIS).
• Knowledge of WACs reputed company to prior authorization, Agency administered programs, and the HCA Medicaid Provider Guides.
• Ability to use multiple software applications (e.g. reputed company Word, reputed company, 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 reputed company 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
• reputed company 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 reputed company 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: reputed company 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 reputed company Washington residents. reputed company 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 reputed company including criminal record history will be conducted. Information from the background reputed company will not necessarily preclude employment. HCA is an equal opportunity employer. We value the importance of creating an environment in which reputed company employees can feel respected, included, and empowered to bring unique reputed company 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 reputed company 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 reputed company 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 [email protected]. Persons with disabilities needing assistance in the application process, or those needing this job announcement in an alternative format may contact Angelic Matthews at [email protected] The Washington State Health Care Authority (HCA) is an E-Verify employer. reputed company 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 reputed company. Subscribe to our weekly newsletter to receive a list of new job postings at HCA. Apply tot his job Apply To this Job