Provider Enrollment Specialist

OrthoVirginia Provider Enrollment Specialist

At OrthoVirginia, you're part of a team dedicated to delivering expert orthopedic and therapy care across the state. As Virginia's largest provider of musculoskeletal care, we offer full-time and part-time opportunities in a collaborative, team-oriented environment.

With more than 159 physicians in over 35 locations—including Lynchburg, Northern Virginia, Richmond, Southwest Virginia, and Hampton Roads—OrthoVirginia is a leader in orthopedic surgery, non-surgical care, and physical, hand, and occupational therapy. Our nationally recognized specialists treat a full range of musculoskeletal injuries and conditions, helping patients of all ages move, heal, and thrive.

Join us and become part of a trusted network committed to excellence in orthopedic care.

Fully Remote - Must be in Virginia

Primary Functions & Accountabilities

• Accurately prepare and submit initial and recredentialing applications for healthcare providers across multiple payers (including Medicare, Medicaid, and private/commercial insurers).
• Ensure each application meets the unique formatting and documentation standards of each insurance carrier.
• Complete enrollment processes for new hires, changes of address, practice relocations, group additions, and terminations.
• Maintain up-to-date records of provider demographics, licensure, certifications, NPI numbers, DEA registrations, malpractice coverage, and other key documentation.
• Enter and update data into internal databases and credentialing software systems (e.g., CAQH, PECOS and others).
• Monitor recredentialing schedules and ensure documents are submitted before expiration to prevent lapses in enrollment or billing interruptions.
• Serve as the main point of contact for providers regarding enrollment status, documentation needs, and compliance updates.
• Coordinate with internal departments such as Human Resources, Credentialing Specialist, Revenue Cycle, and Legal to ensure consistency and accuracy in provider data.
• Liaise directly with payer representatives to resolve issues and expedite enrollment or payer recredentialing.
• Stay informed of changes to federal, state, and payer-specific credentialing requirements.
• Ensure compliance with industry standards including HIPAA, NCQA, URAC, CMS, and other regulatory bodies.
• Assist with internal and external audits, responding to inquiries and providing documentation as needed.
• Track all applications, credentials, and expirables using spreadsheets or credentialing software; generate regular reports on enrollment status and timelines. Identify inefficiencies or gaps in the enrollment process and recommend improvements to policies and procedures.
• Participate in ongoing training and professional development to stay current with payer policies and industry best practices.

Knowledge, Skills & Abilities

• High school diploma or equivalent required.
• Associate or bachelor's degree field strongly preferred.
• Minimum of 3 years of experience in provider enrollment, credentialing, or healthcare administration.
• Experience working with federal programs (Medicare, Medicaid) and commercial payers (e.g., Aetna, Cigna, UnitedHealthcare).
• Familiarity with systems like CAQH, PECOS, NPPES, and provider portals (Availity, NaviNet, etc.).
• Exceptional organizational skills, attention to detail, and the ability to manage multiple priorities under tight deadlines.
• Strong communication and interpersonal skills for working with providers, leadership, and external partners.
• Ability to maintain confidentiality and handle sensitive information with professionalism.

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