Virginia Medicaid Provider Enrollment Field Rep (Hybrid)

Gainwell Technologies; Virginia; Hybrid; USD 56,000 - 80,000; Full time

Benefits offered by this job

401(k) match

Health benefits

Educational assistance

Generous vacation policy

Job summary

Gainwell Technologies is recruiting a Provider Enrollment Field Representative for the Richmond, VA region in a hybrid role. You will act as the main liaison between providers, Virginia Medicaid, and Gainwell to support enrollment, revalidation, screening, and compliance initiatives.

You will conduct outreach, deliver education, perform on-site visits, resolve inquiries, and build strong provider relationships to ensure program integrity and access to care for Virginia Medicaid members.

Qualifications

• Two (2) or more years of experience in provider enrollment, provider relations, revalidation, Medicaid operations, healthcare administration, credentialing, medical billing, compliance, customer service, or related healthcare environment.

Responsibilities

• Serve as the primary point of contact for providers regarding enrollment, revalidation, participation requirements, credentialing, provider maintenance, and program compliance activities.
• Conduct proactive outreach to providers regarding enrollment applications, revalidation requirements, deadlines, corrective actions, and other Virginia Medicaid initiatives.
• Perform in-state site visits for moderate- and high-risk provider enrollments in accordance with CMS, federal, state, and Virginia Medicaid screening requirements.
• Complete site visit documentation, identify potential compliance concerns, and communicate findings in accordance with program policies and established procedures.
• Research, investigate, and resolve provider inquiries related to enrollment, participation requirements, claims, billing, site visits, and Virginia Medicaid provider operations.
• Deliver provider education through webinars, workshops, provider forums, conferences, presentations, and one-on-one consultations.
• Build and maintain productive relationships with healthcare providers, provider associations, community stakeholders, and state partners throughout Virginia.
• Monitor provider participation and outreach activities, identify barriers to enrollment and revalidation completion, and recommend opportunities for process improvement.
• Collaborate with Provider Enrollment, Operations, Quality Assurance, Compliance, Program Integrity, and Client teams to support provider satisfaction and operational excellence.
• Document provider interactions, outreach activities, site visits, and issue resolutions in accordance with contract requirements and established procedures.
• Support special projects and provider engagement initiatives designed to improve provider participation, compliance, data quality, and enrollment outcomes.
• Serve as a trusted resource to Virginia Medicaid providers throughout the enrollment and participation lifecycle.
• Collaborate with operational, compliance, quality, program integrity, and client teams to improve provider engagement and operational performance.
• Participate in provider-focused meetings, conferences, training events, and stakeholder engagement activities.

Skills

Provider enrollment

Medicaid operations

Healthcare administration

Customer service

MS Office

Tools

MS Office

Job description

Gainwell Technologies is recruiting a Provider Enrollment Field Representative for the Richmond, VA region in a hybrid role. You will act as the main liaison between providers, Virginia Medicaid, and Gainwell to support enrollment, revalidation, screening, and compliance initiatives.

You will conduct outreach, deliver education, perform on-site visits, resolve inquiries, and build strong provider relationships to ensure program integrity and access to care for Virginia Medicaid members.