High-Risk Provider Management Supervisor (WMS2/DAIO)

State of Washington•Thurston County – Olympia, WA

3d•Remote

About The Position

The Division of Audit, Integrity, and Oversight (DAIO) is seeking a High-Risk Provider Management Supervisor to lead HCA's new High-Risk Provider Management Team. This team is HCA's primary authority for overseeing high- and moderate-risk Medicaid providers, administering enhanced oversight mechanisms, and developing provider termination and disenrollment recommendations. You will set the policies and procedures that guide consistent risk determinations and enforcement actions, and coordinate with managed care organizations, sister agencies, and law enforcement to bring accountability and transparency to how Medicaid funds are spent. This is a full-time permanent, remote position. Employees may occasionally be asked to attend an in-person meeting or event based on business needs. All HCA employees are required to be Washington state residents upon their first day of employment.

Requirements

Master-level knowledge of health care compliance frameworks, specifically 42 CFR Part 455 (Program Integrity in Medicaid), including 42 CFR 455.470 regarding provider enrollment moratoria.
Demonstrated ability to dissect complex bills and federal legislation, project their operational impacts, advise executive leadership on strategic trade-offs, and translate statutory mandates into actionable Standard Operating Procedures (SOPs).
Demonstrated expertise in authoring administrative summaries, chronological evidence packets, and formal enrollment denial or termination letters that are technically rigorous and legally defensible during provider appeals and hearings.
Demonstrated advanced capabilities in provider risk stratification (Limited, Moderate, High), identifying behavioral red flags, and utilizing data points (geographical data, billing patterns, corporate histories) to confirm provider profiles.
Demonstrated mastery of orchestrating mandatory fingerprint-based criminal background checks (FCBC), managing strict regulatory timelines, and executing enforcement mechanisms for non-compliance.
Proficiency in managing daily high-volume data-matching workflows against federal databases, specifically the HHS/OIG List of Excluded Individuals/Entities (LEIE) and the System for Award Management (SAM).
Demonstrated competency in designing, budgeting, and executing unannounced physical site visits. This includes generating targeted investigator task orders, structural checklists, and maintaining strict behavioral and safety standards for field staff.
Demonstrated mastery of maintaining meticulous, structured, and auditable digital case files that can withstand scrutiny from federal auditors or law enforcement.
Proven ability to interface and coordinate joint efforts with heavy-hitting external oversight bodies, including the Centers for Medicare & Medicaid Services (CMS), the Medicaid Fraud Control Unit (MFCU), Unified Program Integrity Contractors (UPIC), and Recovery Audit Contractors (RAC).
Demonstrated skills in aligning strategies across Managed Care Organizations (MCOs), sister divisions, and Provider Enrollment units to build complex prioritization schedules (e.g., provider revalidation cycles).
Expert mentorship capabilities to upskill section staff, foster a culture of compliance, and lead agency-wide process improvement initiatives alongside senior executives.
Equity lens – All HCA employees are required to consider equity in their decisions, processes, and day-to-day work, including how their work may affect the people and communities we serve.
The ability to take action to learn and grow by seeking new perspectives, learning from experiences, and using what you’ve learned to continuously improve how you work and serve others.
The ability to take action to meet the needs of others by listening, understanding different perspectives, and responding with care, respect, and solutions that support the people of the communities we serve.

Nice To Haves

Supervisory experience, including conducting employee performance reviews.
Demonstrated ability to problem-solve, prioritize workloads, meet deadlines, and provide independent strategic direction and decision-making.
A bachelor's or master's degree in business administration, public administration, contracting, business law, commerce, mathematics, statistics, economics, or a closely allied field.
A law degree from an accredited college or university approved by the Washington State Bar Association.
Demonstrated expert-level experience in the administration of Medicaid funds and expenditures, or experience working with Medicaid or the behavioral health industry.
Ability to clearly communicate complex information, verbally and in writing, to a non-technical audience.

Responsibilities

Supervise a team of professional staff responsible for enhanced oversight, monitoring, and site visits of high- and moderate-risk Medicaid providers.
Assign and elevate provider risk levels, initiate required fingerprint-based criminal background checks, and enforce regulatory deadlines.
Authorize and plan unannounced site visits, develop field task orders and standard operating procedures, and manage the site visit team's budget of approximately $200,000 a year.
Oversee daily screening of providers against the HHS/OIG List of Excluded Individuals/Entities (LEIE) and the System for Award Management (SAM), along with reviews of billing patterns, geographic data, and corporate histories.
Identify red flags, escalate concerns to leadership or HCA's Special Investigations Unit, and coordinate with CMS, law enforcement, the Medicaid Fraud and Abuse Division, and other oversight entities.
Develop legally defensible denial and termination letters, evidence packets, and recommendations that support risk decisions during provider appeal hearings.
Partner with Provider Enrollment on revalidation schedules and on provider termination and enrollment policy recommendations.
Develop policies and procedures for temporary provider moratoria under 42 CFR 455.470.
Analyze legislation affecting program integrity, advise executive leadership, and contribute to WAC development and agency-wide process improvements.