Government/Commercial Program Enrollment & Regulatory Coordinator

University of Virginia

1d•$85,000

About The Position

The Government/Commercial Program Enrollment & Regulatory Coordinator supports the revenue cycle by managing all aspects of facility enrollment with Medicare and Medicaid, including initial enrollments, revalidations, updates, and ongoing maintenance. This role requires a strong understanding of the detailed and evolving rules that govern participation in federal and state programs. In addition to government program enrollment, the coordinator oversees commercial payor enrollment and credentialing activities for the organization’s facilities. This includes ensuring accurate and timely submission of applications, maintaining payor records, and supporting operational readiness for commercial billing. A key responsibility of this position is monitoring Medicare and Medicaid regulatory and policy changes that impact revenue cycle operations. The coordinator evaluates updates from CMS and state Medicaid agencies, synthesizes the information, and distributes clear, actionable guidance across revenue cycle teams to support awareness and education. The role also plays an important part in managing the regulatory landscape for provider based clinics. The coordinator tracks government payor requirements specific to provider based status, assists in assessing the impact of new regulations, and supports the organization’s response to changes affecting these locations.

Requirements

Bachelor’s degree required or relevant experience may be considered in lieu of Bachelor's degree.
A minimum of five years of experience required in a complex hospital setting
Knowledge of third party billing and reimbursement methodologies required
Understanding of CPT level II and III HCPCS and hospital charging methods is essential
General comprehension of medical terminology is necessary.

Responsibilities

Manage end‑to‑end Medicare and Medicaid enrollment processes, including initial applications, revalidations, ownership/structure updates, and change‑of‑information filings.
Oversee commercial payor enrollment and credentialing activities for all facilities, ensuring timely and accurate submission of required documentation.
Maintain comprehensive, audit‑ready records of enrollment statuses, expirations, correspondence, and supporting documents.
Monitor CMS, MAC, and state Medicaid regulatory updates; assess operational impact and translate changes into clear, actionable guidance for revenue cycle teams.
Serve as a subject‑matter expert on government program participation requirements, commercial payor expectations, and enrollment‑related regulatory rules.
Collaborate with compliance, legal, and operational leaders to identify regulatory risks and support mitigation strategies tied to enrollment or billing privileges.
Coordinate closely with Joint Commission accreditation teams, compliance, and internal/external legal counsel to ensure enrollment activities align with regulatory, accreditation, and organizational requirements.
Participate in facility structure meetings and track agenda items to ensure new additions or modifications are captured and incorporated into enrollment and regulatory workflows.
Support provider‑based clinic regulatory oversight by tracking location‑specific requirements, evaluating new regulations, and coordinating organizational responses.
Partner with IT and revenue cycle operations to ensure enrollment data is accurately reflected in billing systems and aligned with payor requirements.
Develop and maintain standard operating procedures, workflows, and training materials related to enrollment and regulatory updates.