Provider Enrollment Specialist

## Provider Enrollment SpecialistApplylocations: Hybridtime type: Full timeposted on: Posted Yesterdayjob requisition id: JR101249At 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. #J-18808-Ljbffr