State of Washington Classified Job Specification
MEDICAL PROGRAM ASSISTANT
Definition
This is a paraprofessional position coordinating healthcare provider credentialing activities to determine healthcare provider eligibility to participate within the state’s healthcare provider network.
Within established parameters and using existing procedures, assists professional level staff, within a healthcare or health services unit, in coordinating healthcare best practice activities, medical necessity or clinical quality reviews.
Within established parameters and using existing procedures, assists professional level staff, within a healthcare or health services unit, in coordinating healthcare best practice activities, medical necessity or clinical quality reviews.
Distinguishing Characteristics
The Medical Program Assistant performs routine duties and tasks using existing procedures and processes.
Positions performing clerical work a majority of the time, in support of a health care program are not intended to be allocated to this series.
Positions performing clerical work a majority of the time, in support of a health care program are not intended to be allocated to this series.
Typical Work
Reviews healthcare provider applications for completeness;
Determines if provider applications meet the standards for participation in the state’s healthcare provider network, or provider network delegation;
Researches and verifies provider education, certification, licensing, Drug Enforcement Administration (DEA) and malpractice insurance and sanctions, state and national criminal background check, and performance according to RCW and/or WAC;
Analyzes descriptors within file related to occupation and/or medical condition to interpret and assign Occupational Injury and Illness Classification System (OIICS) and standard occupational classification;
Assists unit and/or health services professional staff to coordinate follow up of information required for medical necessity and/or clinical quality reviews to include reviewing records for completeness while using appropriate standard protocol; routing and tracking of documents.
Determines if provider applications meet the standards for participation in the state’s healthcare provider network, or provider network delegation;
Researches and verifies provider education, certification, licensing, Drug Enforcement Administration (DEA) and malpractice insurance and sanctions, state and national criminal background check, and performance according to RCW and/or WAC;
Analyzes descriptors within file related to occupation and/or medical condition to interpret and assign Occupational Injury and Illness Classification System (OIICS) and standard occupational classification;
Assists unit and/or health services professional staff to coordinate follow up of information required for medical necessity and/or clinical quality reviews to include reviewing records for completeness while using appropriate standard protocol; routing and tracking of documents.
Knowledge and Abilities
Knowledge of: healthcare credentialing processes and procedures; health care payment and best practices programs; and/or knowledge of medical terminology.
Ability to: work effectively with program staff, medical providers, and other internal and external parties; communicate clearly and effectively both orally and in written form.
Ability to: work effectively with program staff, medical providers, and other internal and external parties; communicate clearly and effectively both orally and in written form.
Legal Requirement(s)
There may be instances where individual positions must have additional licenses or certification. It is the employer’s responsibility to ensure the appropriate licenses/certifications are obtained for each position.
Persons legally authorized to work in the U.S. under federal law, including Deferred Action for Childhood Arrivals recipients, are eligible for employment unless prohibited by other state or federal law.
Persons legally authorized to work in the U.S. under federal law, including Deferred Action for Childhood Arrivals recipients, are eligible for employment unless prohibited by other state or federal law.
Desirable Qualifications
High school diploma or equivalent, and at least two years of experience providing assistance to customers regarding inquires, complaints or problems preferably within a medical setting.
Note: Some positions may require a current Certified Provider Credentialing Specialist certification from National Association Medical Staff Services (NAMSS), or equivalent, to be obtained within two years of employment.
Note: Some positions may require a current Certified Provider Credentialing Specialist certification from National Association Medical Staff Services (NAMSS), or equivalent, to be obtained within two years of employment.
Class Specification History
New class. Adopted June 13, 2019, effective July 1, 2019.
Revised Legal Requirements; effective June 6, 2024, due to adopted legislative action.
Revised Legal Requirements; effective June 6, 2024, due to adopted legislative action.
