What are the responsibilities and job description for the Medicaid Program Manager 2 (Medicaid Provider Enrollment Manager) position at LDH-Medical Vendor Administration?
About this Job
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.
Learn more about Louisiana Department of Health
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.Minimum Qualifications
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.
EXPERIENCE SUBSTITUTION:
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.
Job Specification
The official job specifications for this role, as defined by the State Civil Service, can be found here.
Job Duties and Other Information
- 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.
Applicants with the following experience and skills are encouraged to apply:
- 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.
Position-Specific Details:
Location: Medical Vendor Administration / Program Operations and Compliance/ East Baton Rouge Parish
Appointment Type: This position may be filled as a Probationary appointment, Promotional appointment, Job appointment, or Detail to Special Duty
Cost Center: 3052020600
Position Number(s): 171563
How To Apply:
No Civil Service test score is required in order to be considered for this vacancy.
Applicants are responsible for checking the status of their application to determine where they are in the recruitment process. Further status message information is located under the Information section of the Current Job Opportunities page.
- Information to support your eligibility for the position must be included in the application (i.e., relevant, detailed experience/education). Resumes will not be accepted in lieu of completed education and experience sections. Applications may be rejected if incomplete.
Contact Information:
Shambrielle Pooler
Shambrielle.Pooler@la.gov
LA Department of Health (LDH)
Division of Human Resources
PO Box 4818
Baton Rouge, LA 70821
225-342-6477
This organization participates in E-verify, and for more information on E-verify, please contact DHS at 1-888-464-4218.
LDH supports Louisiana’s commitment to being a State as a Model Employer (SAME) by promoting the recruitment, hiring, and retention of individuals with disabilities.
Information on the Louisiana Works, Louisiana Rehabilitation Services is available here.
LDH is an equal opportunity employer and seeks to recruit a highly productive and diverse workforce and will provide equal employment opportunities to all employees and prospective employees. Employment decisions shall be based strictly on merit and without regard to religious or political beliefs, sex, race, or any other non-merit factor.
As a state employee, you will earn competitive pay, choose from a variety of benefits, and have access to a great professional development program:
Insurance Coverage More information can be found at https://info.groupbenefits.org/
Parental Leave – Up to six weeks paid parental leave
More information can be found at https://www.civilservice.louisiana.gov/Parental-Leave/Default.aspx
Holidays and Leave – State employees receive the following paid holidays each year:
- New Year's Day
- Martin Luther King, Jr. Day,
- Mardi Gras,
- Good Friday,
- Memorial Day,
- Independence Day,
- Labor Day,
- Veteran's Day,
- Thanksgiving Day and Christmas Day.
State employees earn sick and annual leave which can be accumulated and saved for future use. Your accrual rate increases as your years of service increase.
Retirement – State of Louisiana employees are eligible to participate in various retirement systems (based on the type of appointment and agency for which an employee works). These retirement systems provide retirement allowances and other benefits for state officers and employees and their beneficiaries. State retirement systems may include (but are not limited to):
- Louisiana State Employees Retirement System (www.lasersonline.org). LASERS has provided this video to give you more detailed information about their system
- Teacher's Retirement System of Louisiana (www.trsl.org),
- Louisiana School Employees Retirement System (www.lsers.net), among others
Salary : $5,751 - $11,284