DSHS HCLA Social & Health Program Consultant 2

About the role

The Home and Community Living Administration (HCLA) is seeking a Social and Health Program Consultant 2 (HCBS Payment Specialist: Residential Specialist) to join our team. In this role, you will help protect the integrity of Home and Community-Based Services (HCBS) by ensuring various types of care providers are paid accurately and in accordance with state and federal requirements. You'll investigate payment discrepancies, analyze complex payment data, resolve underpayments and overpayments, and collaborate with internal teams and external partners to improve payment processes. Your expertise will directly support providers, strengthen program accountability, and help ensure public resources are managed responsibly while supporting Washingtonians who rely on critical long-term care services.

Responsibilities

• Investigate and resolve complex provider payment discrepancies, including identifying underpayments and overpayments through data analysis and research.
• Support the unit's Billing and Payments Program Manager by serving as a subject matter expert and point of contact for residential payment integrity, authorizations, and Adult Family Home payment issues, providing technical assistance and guidance to staff and providers.
• Analyze social service authorizations, claims, contracts, and payment data across multiple state systems to determine payment accuracy and identify the root cause of discrepancies.
• Initiate and monitor payment adjustments and overpayment recoveries while coordinating with internal and external partners to ensure timely resolution.
• Develop, maintain, and improve payment integrity procedures, documentation, reports, and training materials to support consistent statewide practices.
• Document investigative findings, prepare evidence for Administrative Hearings, and provide expert testimony when needed.
• Coordinate Change of Ownership (CHOW) communications for residential providers by tracking notifications, maintaining records, and ensuring accurate information is shared across programs.

Qualifications

We are searching for professionals with:

• A master's degree or higher in social work, a health or social science, public administration, or a related field and two years of professional experience planning, administering, developing, or delivering social, financial, health, or chemical dependency treatment services programs; OR
• A bachelor's degree in social work, a health or social science, public administration, or a related field and three years of professional experience planning, administering, developing, or delivering social, financial, health, or chemical dependency treatment services programs; OR
• One year of experience as a Social and Health Program Consultant 1; OR
• Seven to eight years of combined professional and practical experience planning, administering, developing, or delivering social, financial, health, or chemical dependency treatment services programs.

Skills

• Strong ability to analyze complex payment, claims, and program data, make sound decisions, and resolve issues involving conflicting information.
• Knowledge of Home and Community-Based Services provider payments, regulations, policies, and payment integrity principles.
• Experience using ProviderOne, CARE, and other related systems to research, process, and resolve provider payment issues.
• Ability to work independently while managing multiple priorities, meeting deadlines, and adapting to changing business needs.
• Excellent written and verbal communication skills, including the ability to explain complex payment concepts to diverse audiences.
• Ability to build collaborative relationships with program staff, technical teams, providers, and external partners to achieve shared outcomes.
• Proficiency using Microsoft Outlook, Word, Excel, Teams, and other computer applications to analyze information and produce reports.
• Uses critical thinking and sound judgment to analyze information, ask questions, and identify appropriate resources when answers are not immediately available.