Medicaid Program Manager 2 (Medicaid Provider Enrollment Manager)

State of Louisiana•Baton Rouge, LA

1d•Onsite

About The Position

The mission of the Louisiana Department of Health is to protect and promote health and to ensure access to medical, preventive, and rehabilitative services for all residents of the State of Louisiana. The Provider Enrollment Manager is responsible for overseeing Louisiana Medicaid's provider enrollment program and ensuring compliance with federal and state provider enrollment requirements. This position provides operational oversight of the State's contracted enrollment vendor and Medicaid staff responsible for provider screening, enrollment, revalidation, disclosures, and provider maintenance activities. The position serves as a subject matter expert on Medicaid provider enrollment policy and works closely with CMS, providers, managed care organizations, licensing boards, and internal stakeholders to ensure efficient provider enrollment operations.

Requirements

Seven years of experience in developing, managing, or evaluating health or social service programs; or in public health, public relations, social services, health services, health regulation, or administrative services; OR Six years of full-time work experience in any field plus four years of experience in developing, managing, or evaluating health or social service programs; or in public health, public relations, social services, health services, health regulation, or administrative services; OR A bachelor’s degree plus four years of experience in developing, managing, or evaluating health or social service programs; or in public health, public relations, social services, health services, health regulation, or administrative services; OR An advanced degree or a Juris Doctorate plus three years of experience in developing, managing, or evaluating health or social service programs; or in public health, public relations, social services, health services, health regulation, or administrative services.
Every 30 semester hours earned from an accredited college or university will be credited as one year of experience towards the six years of full-time work experience in any field. The maximum substitution allowed is 120 semester hours which substitutes for a maximum of four years of experience in any field.

Nice To Haves

Experience in Medicaid, healthcare administration, provider enrollment, program integrity, or related healthcare operations.
Knowledge of Medicaid provider enrollment requirements and healthcare regulatory compliance.
Experience managing contracts, vendor relationships, and complex operational programs.
Strong analytical, organizational, and problem-solving skills.
Ability to interpret regulations, develop policy, and implement operational improvements.
Excellent written and verbal communication skills.
Experience managing projects, stakeholders, and professional staff.
Commitment to improving program performance and provider experience.

Responsibilities

Provide oversight of Louisiana Medicaid's provider enrollment program and contracted enrollment vendor.
Monitor compliance with federal and state provider enrollment requirements, including provider screening, disclosures, revalidation, enrollment moratoria, and program integrity initiatives.
Develop, interpret, and implement provider enrollment policies, procedures, and operational guidance.
Oversee contractor performance, service level agreements, operational metrics, and corrective action activities.
Coordinate implementation of provider enrollment initiatives, system enhancements, federal mandates, and policy changes.
Collaborate with program integrity, legal, audit, compliance, managed care, and operational teams on provider enrollment issues and investigations.
Serve as a liaison with CMS, providers, managed care organizations, licensing boards, and other stakeholders.
Analyze operational data and performance trends to improve efficiency, compliance, and provider experience.
Prepare reports, presentations, policy memoranda, and executive briefings for agency leadership.
Supervise professional staff, establish performance expectations, conduct evaluations, and provide ongoing coaching and development.
Manage special projects and perform other duties as assigned to support the goals and operations of the Section.