Government Program Network Engagement Specialist
New
United StatesFull-TimeMiddle
Salary66,600 - 111,000 USD per year
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Job Details
- Experience
- 4+ years
- Required Skills
- Analytical SkillsMicrosoft ExcelOrganizational skillsComplianceProcess improvement
Requirements
- High school diploma or GED required
- 4+ years of direct experience with Medicaid provider enrollment, government programs, or payer operations preferred
- Demonstrated deep knowledge of state Medicaid regulatory and enrollment processes preferred
- Proven experience working directly with state agencies, Medicaid MCOs, or government payers preferred
- Strong provider-facing communication skills with the ability to explain complex regulations clearly
- High confidence interacting with regulators, providers, and executive stakeholders
- Advanced analytical skills with experience tracking metrics, building reports, and identifying trends
- Strong Excel skills (pivot tables, formulas, data analysis)
- Experience with dashboards and reporting tools preferred
- Exceptional organizational skills with the ability to manage multiple states, timelines, and priorities
- Familiarity with credentialing systems, payer enrollment platforms, and provider data management
- Experience presenting data and progress updates to senior leadership
- Background in process improvement, compliance, or risk mitigation within healthcare operations
Responsibilities
- Serve as primary point of contact for assigned state Medicaid agencies, Medicaid MCOs, and providers.
- Maintain expert‑level knowledge of state‑specific Medicaid enrollment, revalidation, linking, and termination requirements.
- Own end‑to‑end Medicaid enrollment and linking outcomes for an assigned group of states.
- Proactively manage regulatory changes, renewals, audits, and revalidations to ensure uninterrupted provider participation.
- Ensure providers are enrolled, linked, billable, and compliant within required state timelines.
- Actively prevent enrollment lapses and terminations through tracking, outreach, and proactive revalidation management.
- Build and maintain trusted relationships with state regulators and payer partners to resolve enrollment issues and escalations.
- Engage directly with providers to explain Medicaid requirements, enrollment status, timelines, and next steps.
- Translate regulatory requirements into clear, actionable guidance for providers and internal stakeholders.
- Represent the voice of the provider in Medicaid workflows, process improvements, and issue resolution.
- Partner closely with Network Recruiters to support hiring priorities aligned to state Medicaid needs.
- Collaborate with Credentialing on applications, verifications, renewals, linking, and data accuracy.
- Work cross‑functionally with Operations, Finance, and Leadership to resolve enrollment blockers impacting access or revenue.
- Support development and refinement of standard operating procedures across government programs.
- Track, analyze, and report Medicaid enrollment metrics by state, provider, and timeline.
- Develop executive‑ready reporting on performance, risks, trends, compliance, and continuity of enrollment.
- Use data and analysis to identify gaps, improve enrollment speed, inform strategy, and support leadership decision‑making.
- Measure success by number of enrolled and linked providers, timeliness and accuracy, reduced lapses, provider satisfaction, reporting quality, and strength of state and MCO relationships.
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