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. This organization participates in e-Verify. Esta organización participa en e-Verify.