Remote High-Risk Medicaid Provider Lead

Washington State Health Care Authority; Olympia (WA); Remote; USD 110,000 - 160,000; Full time

Benefits offered by this job

Remote work

Flexible schedules

Medical, dental, vision, life

Paid vacation, sick leave & holidays

PFML

Retirement options

Professional development

Wellness programs

Job summary

Washington State Health Care Authority is seeking a High-Risk Provider Management Supervisor to lead a new team overseeing high- and moderate-risk Medicaid providers. The role develops policies for risk determinations, conducts sensitive investigations, and coordinates with CMS and law enforcement to ensure program integrity.

Remote work is available with occasional in-person meetings; 40-hour weeks with potential travel for meetings.

Qualifications

• Master-level knowledge of health care compliance frameworks (42 CFR Part 455)
• Ability to dissect complex bills and translate mandates into SOPs
• Experience authoring legally defensible enrollment letters and packets

Responsibilities

• Supervise a team responsible for enhanced oversight and site visits of high- and moderate-risk providers
• Assign and elevate provider risk levels and conduct background checks
• Plan unannounced site visits and manage a $200,000 annual budget for the site visit team
• Oversee LEIE and SAM screening and review billing patterns and provider histories
• Identify red flags and coordinate with CMS, law enforcement, and other entities
• Develop legally defensible denial and termination letters and recommendations
• Collaborate with Provider Enrollment on revalidation schedules and policy recommendations
• Develop policies for provider moratoria under 42 CFR 455.470
• Analyze legislation and contribute to SOPs and agency processes

Skills

Regulatory compliance

Leadership

Policy analysis

Stakeholder collaboration

Risk assessment

Education

Bachelor's degree in related field

Job description

Washington State Health Care Authority is seeking a High-Risk Provider Management Supervisor to lead a new team overseeing high- and moderate-risk Medicaid providers. The role develops policies for risk determinations, conducts sensitive investigations, and coordinates with CMS and law enforcement to ensure program integrity.

Remote work is available with occasional in-person meetings; 40-hour weeks with potential travel for meetings.