Provider Enrollment Field Representative- Richmond, VA (Hybrid)

Summary

The Provider Field Representative serves as the primary liaison between Gainwell Technologies, Virginia Medicaid, and the provider community throughout the Commonwealth of Virginia. This role supports provider enrollment, revalidation, screening, participation, and compliance initiatives by serving as a trusted resource for healthcare providers and provider organizations.

The Provider Field Representative partners directly with physicians, clinics, hospitals, behavioral health providers, long-term care facilities, and other healthcare organizations to promote successful participation in the Virginia Medicaid program. This position is responsible for conducting provider outreach, delivering provider education, performing on-site screening activities, resolving provider inquiries, and fostering strong provider relationships that support program integrity, provider compliance, and access to care for Virginia Medicaid members.

Your role in our mission

• 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.

What we're looking for

• Two (2) or more years of experience in provider enrollment, provider relations, revalidation, Medicaid operations, healthcare administration, credentialing, medical billing, compliance, customer service, or a related healthcare environment.
• Experience working directly with physicians, healthcare facilities, behavioral health providers, long-term care providers, or other healthcare organizations with knowledge of provider screening requirements and participation standards.
• Experience conducting provider education, outreach, training, audits, inspections, site visits, or other provider-facing activities is preferred.
• Strong presentation, communication, and relationship-building skills with an ability to analyze provider issues, identify solutions, and communicate complex information in a clear and professional manner
• Strong organizational skills with the ability to manage multiple priorities and deadlines.
• Proficiency with Microsoft Office applications including Outlook, Excel, Word, Teams, and PowerPoint.

What you should expect in this role

This is a hybrid position for Richmond, VA. Candidates must reside in the state of Virginia.

• Conduct travel throughout Virginia to perform provider site visits and support provider outreach activities.
• Hybrid work environment with regular travel throughout the Commonwealth of Virginia based on business and program needs.
• Assessment Requirement: Candidates will be required to complete a skills and competency assessment before advancing to the next stage of the selection process
• The work schedule is Monday through Friday, 8:00 AM to 5:00 PM CST.
• Video cameras must be used during all interviews, as well as during the initial week of orientation.

   

  The deadline to submit applications for this posting is November 2, 2026. 

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