Bureau of Provider Enrollment Director; Health Program Director

Duties Description
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.

Description

Duties Description
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…