Bureau of Provider Enrollment Director (Health Program Director 1) - 4144

The Health Program Director 1 (HPD1) will serve as the Director for the Bureau of Provider Enrollment (BPE), responsible for enrolling, maintaining, and revalidating more than 240,000 Medicaid providers (e.g., over 200,000 individual providers, more than 10,000 businesses, 11,000 practitioner groups, and 10,000 institutional providers). Proper enrollment is critical for providers to get reimbursed for essential care delivered to NYS Medicaid Members and to mitigate fraud, waste, and abuse within the Medicaid program. Core functions of the Bureau include all enrollment-related transactions, training and quality assurance, provider relationship management, program integrity, answering audits, and executing required data reporting. The Bureau partners with many different programs within OHIP, including but not limited to NYRx, dental, health access, maternal & child health, laboratory, and durable medical equipment policy teams. In addtion BPE is the lead Bureau to Centers for Medicare and Medicaid Services (CMS) enrollment division, to NYS agencies including but not limited to Office for Alcohol and Substance Abuse Services (OASAS), Office of Mental Health (OMH), and Office for People with Developmental Disabilities (OPWDD). BPE also works together with the Office of the Medicaid Inspector General (OMIG) on fraud, waste, and abuse referrals as well as enrollment appeals and sanctions.

In 2025, BPE launched the first ever electronic Provider Services Portal (PSP) for enrollment, replaceing a paper process. In April of 2026, CMS announced an initiative to revalidate all Medicaid providers within a two-year time period. The Bureau has developed a robust revalidation plan to accomplish the requirement.

- The Health Program Director 1 (HPD1) will serve as the Director for the Bureau of Provider Enrollment, providing expert-level programmatic guidance and coordinating the work of approximately 40+ staff engaged in enrollment operations.

- Serve as a Subject Matter Expert for Medicaid provider enrollment, applying in-depth knowledge of federal and State regulations, policies, and procedures to resolve complex programmatic issues.

- Oversee and coordinate all transactions for Medicaid provider enrollment for over 240,000 enrolled providers, ensuring accuracy, timeliness, and compliance with applicable requirements.

- Monitor and coordinate vendor contracts related to enrollment activities (e.g., Provider Services Portal, Site Visits), and provide expert analysis and recommendations for the development and implementation of new contracts as needed.

- Provide senior-level programmatic expertise in the design, development, and implementation of an ongoing effort to replace Medicaid Management Information System functionality for provider enrollment, including web portal enhancements, transactional efficiency improvements, program integrity controls, and coordination of contractor staff completing enrollment transactions.

- Analyze and interpret federal and State Medicaid provider enrollment regulations to ensure operational compliance, including requirements for program integrity checks, revalidation of provider enrollment at least every five years, and enrollment of Medicaid managed care organization network providers into fee-for-service Medicaid under the 21st Century Cures Act.

- Act as representative with Federal CMS, participate in national meetings.

- Coordinate activities within DOH and with external agencies (e.g., OMH, OPWDD, OALTC) to support the creation and addition of new provider categories and other enrollment changes necessitated by Medicaid Program developments.

- Develop and implement staff production criteria and quality assurance standards, and provide technical guidance, training, and mentoring to staff to strengthen operational capacity and support workforce development.

- Research, analyze, and resolve complex inquiries and issues from providers, stakeholders, legislators, the federal government, audit and prosecutorial entities, and the public.

- Lead program integrity for Provider Enrollment by coordinating with the provider sanction process, ensuring appropriate and timely actions in collaboration with the Office of Medicaid Inspector General, Attorney General’s Medicaid Fraud Unit (MFCU) the Division's Bureau of Managed Care Certification and Surveillance, Bureau of Managed Care Fiscal Oversight, and the Office of Quality and Patient Safety – Provider Network Data System.

- Conduct outreach to providers to encourage participation in the Medicaid program and provide technical assistance related to enrollment requirements.

- Participate in meetings and negotiations with OHIP and DOH executive staff and other New York State agencies, serving as a senior programmatic representative for provider enrollment matters.

- Evaluate the performance, accomplishments, and effectiveness of the Bureau's program operations, and prepare detailed analyses and recommendations for the Division Director of OHIP Operations to support the achievement of Division objectives.
Eleven years of professional level work experience, two of which must have included managerial, decision-making, and/or oversight of a major health-related program or in the direction of a major administrative function of a large health related organization. A bachelor’s degree may be substituted for four years of the general professional experience; a master’s degree in an appropriate field may be substituted for an additional year of that experience.

Preferred Qualifications: The candidate should have demonstrated experience working with the New York State Medicaid program. We are looking for a strong leader with a track record of advancing programs by articulating goals, planning, and implementing processes to achieve those goals. The candidate should have experience interpreting and implementing federal or state legislation, as well as drafting, revising, and implementing new or modifying New York State regulations. The preferred candidate should have a track record of successfully engaging with a range of stakeholders in interagency and state/federal settings to implement programs or policies. The candidate should have experience setting standards, developing quality protocols for processes, and have strong analytical, written, and oral communication skills.