Provider Network Management Jobs in District of Columbia
Provider Network Management jobs in District of Columbia concentrate heavily in federal health policy, managed care, and health insurance sectors, reflecting the region's unique position as home to major government contractors, trade associations, and national payers. Most hiring activity centers on Washington DC proper, with strong demand also in the surrounding Northern Virginia and Maryland suburbs, where organizations like CareFirst BlueCross BlueShield, Elevance Health, and AmeriHealth Caritas maintain significant operations. Credentialing, contract negotiation, and value-based care network strategy are the most in-demand specialties, with openings across coordinator, analyst, and director levels. See the openings below and apply to the ones that match your experience.
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The Sr. Medicare (PPS) Provider Hospital Reimbursement Analyst (Senior Business Systems Analysis Professional) will be an integral part of the Pricer Business and System Support team responsible for administering complex Medicare provider reimbursement methodologies. The business needs of the team continue to evolve and grow, changing the composition of the team as it expands to accommodate the increased responsibilities.The Medicare (PPS) Provider Hospital Reimbursement Analyst also known as a Senior Business Systems Analysis Professional will be an integral part of the Pricer Business and System Support team responsible for administering complex Medicare provider reimbursement methodologies. The business needs of the team continue to evolve and grow, changing the composition of the team as it expands to accommodate the increased responsibilities.
The Senior Business Systems Analysis Professional will be primarily responsible for maintenance and support of Medicare outpatient provider reimbursement for hospitals and facilities. They will work closely with IT, the pricing software vendor, CIS BSS, claims operations, and other business teams involved in the administration of Medicare business at Humana. The Senior Business Systems Analysis Professional will develop and maintain expertise in complex Medicare reimbursement methodologies. This role is within the Integrated Pricing Solutions (IPS) department which falls under the Provider Network Operations (PNO).
The Senior Provider Hospital Reimbursement Analyst will be responsible for:
- Researching and maintaining expertise in Medicare Outpatient Prospective Payment System reimbursement methodologies (OPPS, ASC, FQHC, etc.)
- Demonstrating expertise in Medicare Integrated Outpatient Code Editor (I/OCE) logic (i.e. grouping rules, OCE data files, editing, etc.)
- Analyzing and interpreting CMS Regulatory documentation for Medicare Prospective Payment Systems (i.e. final and proposed rules, transmittals, manuals, legislation, etc.)
- Supporting implementation of Medicare pricer projects and enhancements
- Reviewing pricing software vendor specifications;
- Identifying system changes needed to accommodate CMS logic;
- Assisting with requirements development;
- Creating and executing comprehensive test plans
- Ongoing Medicare pricer maintenance, quality assurance, and compliance
- Determine root causes driving issues and developing solutions
- Working closely with IT and pricing software vendor to resolve issues
- Utilize data and expertise to identify automation and improvement opportunities
- Research and resolve complex provider reimbursement inquiries and advise operational teams on pricer edit resolution
- Provide consultation to internal business partners on Medicare reimbursement/editing logic and Humana system logic
Use your skills to make an impact
Required Qualifications
- Minimum 3 years of experience researching Medicare Prospective Payment System (PPS) reimbursement methodologies for hospitals
- Minimum 3 years of experience reviewing facility claims
- Minimum 2 years of experience with Optum Rate Manager
- Strong oral and written communication skills
Work-At-Home Requirements
- At minimum, a download speed of 25 mbps and an upload speed of 10 mbps is recommended; wireless, wired cable or DSL connection is suggested
- Satellite, cellular and microwave connection can be used only if approved by leadership
- Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
- Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
- Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
Preferred Qualifications
- Bachelor’s Degree
- Experience with Optum WebStrat or Optum Payment System Interface (PSI) applications
- Experience researching Medicare Integrated Outpatient Code Editor (I/OCE) logic
- Experience working with Optum EASYGroup software
Additional Information
- As part of our hiring process for this opportunity, we may contact you via text message and email to gather more information using a software platform called HireVue. HireVue Text, Scheduling and Video technologies allow you to interact with us at the time and location most convenient for you.
- If you are selected to move forward from your application prescreen, you may receive correspondence inviting you to participate in a pre-recorded Voice, Text Messaging and/or Video interview. Your recorded interview will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.
Scheduled Weekly Hours
Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$80,900 - $110,300 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About us
About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Become a part of our caring community
The Sr. Medicare (PPS) Provider Hospital Reimbursement Analyst (Senior Business Systems Analysis Professional) will be an integral part of the Pricer Business and System Support team responsible for administering complex Medicare provider reimbursement methodologies. The business needs of the team continue to evolve and grow, changing the composition of the team as it expands to accommodate the increased responsibilities.The Medicare (PPS) Provider Hospital Reimbursement Analyst also known as a Senior Business Systems Analysis Professional will be an integral part of the Pricer Business and System Support team responsible for administering complex Medicare provider reimbursement methodologies. The business needs of the team continue to evolve and grow, changing the composition of the team as it expands to accommodate the increased responsibilities.
The Senior Business Systems Analysis Professional will be primarily responsible for maintenance and support of Medicare outpatient provider reimbursement for hospitals and facilities. They will work closely with IT, the pricing software vendor, CIS BSS, claims operations, and other business teams involved in the administration of Medicare business at Humana. The Senior Business Systems Analysis Professional will develop and maintain expertise in complex Medicare reimbursement methodologies. This role is within the Integrated Pricing Solutions (IPS) department which falls under the Provider Network Operations (PNO).
The Senior Provider Hospital Reimbursement Analyst will be responsible for:
- Researching and maintaining expertise in Medicare Outpatient Prospective Payment System reimbursement methodologies (OPPS, ASC, FQHC, etc.)
- Demonstrating expertise in Medicare Integrated Outpatient Code Editor (I/OCE) logic (i.e. grouping rules, OCE data files, editing, etc.)
- Analyzing and interpreting CMS Regulatory documentation for Medicare Prospective Payment Systems (i.e. final and proposed rules, transmittals, manuals, legislation, etc.)
- Supporting implementation of Medicare pricer projects and enhancements
- Reviewing pricing software vendor specifications;
- Identifying system changes needed to accommodate CMS logic;
- Assisting with requirements development;
- Creating and executing comprehensive test plans
- Ongoing Medicare pricer maintenance, quality assurance, and compliance
- Determine root causes driving issues and developing solutions
- Working closely with IT and pricing software vendor to resolve issues
- Utilize data and expertise to identify automation and improvement opportunities
- Research and resolve complex provider reimbursement inquiries and advise operational teams on pricer edit resolution
- Provide consultation to internal business partners on Medicare reimbursement/editing logic and Humana system logic
Use your skills to make an impact
Required Qualifications
- Minimum 3 years of experience researching Medicare Prospective Payment System (PPS) reimbursement methodologies for hospitals
- Minimum 3 years of experience reviewing facility claims
- Minimum 2 years of experience with Optum Rate Manager
- Strong oral and written communication skills
Work-At-Home Requirements
- At minimum, a download speed of 25 mbps and an upload speed of 10 mbps is recommended; wireless, wired cable or DSL connection is suggested
- Satellite, cellular and microwave connection can be used only if approved by leadership
- Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
- Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
- Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
Preferred Qualifications
- Bachelor’s Degree
- Experience with Optum WebStrat or Optum Payment System Interface (PSI) applications
- Experience researching Medicare Integrated Outpatient Code Editor (I/OCE) logic
- Experience working with Optum EASYGroup software
Additional Information
- As part of our hiring process for this opportunity, we may contact you via text message and email to gather more information using a software platform called HireVue. HireVue Text, Scheduling and Video technologies allow you to interact with us at the time and location most convenient for you.
- If you are selected to move forward from your application prescreen, you may receive correspondence inviting you to participate in a pre-recorded Voice, Text Messaging and/or Video interview. Your recorded interview will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.
Scheduled Weekly Hours
Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$80,900 - $110,300 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About us
About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
See All 36 Provider Network Management Jobs in District of Columbia
Find roles in District of Columbia that match your experience and apply in just a few clicks.
Find JobsProvider Network Management Jobs by City in District of Columbia
Where District of Columbia roles are concentrated, by current openings.
Provider Network Management Job Market in District of Columbia
A snapshot from current District of Columbia openings, updated as new roles post.
Who's Hiring
- Children's National Hospital24
- MedStar Health5
- Humana1
- Talkiatry1
- Signet Health1
Top Industries Hiring
- Healthcare & Medical Services25
What District of Columbia Employers Look For
The qualifications that appear most often in provider network management jobs across District of Columbia.
- Experience with provider contract negotiation and network adequacy standards in regulated markets
- Familiarity with credentialing processes, NCQA standards, and provider data management systems
- Proficiency with network management platforms such as FACETS, QNXT, or similar claims systems
- Strong knowledge of CMS regulations, Medicaid managed care requirements, and federal contracting rules
- Bachelor's degree in health administration, public health, business, or a closely related field
- Excellent analytical and relationship-building skills for managing multi-specialty provider relationships
Provider Network Management Jobs in District of Columbia: Frequently Asked Questions
How do you become a provider network management in District of Columbia?
Most provider network management roles in DC require a bachelor's degree in health administration, public health, or a related field, though many employers prefer candidates with a master's degree given the policy-heavy environment. There is no state-issued license specific to this role in DC, but professionals working with Medicaid managed care organizations operating under DC Department of Health Care Finance contracts benefit from direct familiarity with DC's Medicaid program requirements and local regulatory structure. Certifications such as the Certified Provider Credentialing Specialist credential strengthen candidacy considerably.
How much do provider network managements make in District of Columbia?
Provider network managements in District of Columbia earn a median of about $155,140 a year, based on May 2025 Bureau of Labor Statistics wage data, ranging from around $95,860 for the lowest 10% to over $227,270 for the top 10%. Pay rises with experience, specialty, and employer.
Which companies hire provider network managements in District of Columbia?
Employers hiring provider network managements in District of Columbia right now include Children's National Hospital, MedStar Health, and Humana, based on current listings on Migrate Mate as of July 2026. DC's concentration of national health plans, federal contractors, and managed care organizations serving Medicaid and government employee populations makes it one of the more consistent hiring markets for this role in the country.
Which District of Columbia cities have the most provider network management jobs?
Washington account for the largest share of provider network management openings in District of Columbia. Washington DC itself dominates due to the density of national payers, government contractors, and federal health agencies headquartered or regionally based there, while nearby suburban clusters in Northern Virginia and suburban Maryland generate additional volume from managed care plan offices and health system administrative centers serving the broader metro population.
Are there remote provider network management jobs in District of Columbia?
Yes, and more than many healthcare roles. Provider network management is largely desk-based work involving contract review, data analysis, and provider communications, which lends itself well to remote arrangements. About 11% of provider network management openings tied to District of Columbia are remote or hybrid as of July 2026, reflecting the administrative nature of the work. Contract negotiation and network analytics positions are the sub-functions most commonly offered with full remote or hybrid flexibility by DC-area employers.
How can I get hired as a provider network management in District of Columbia with little or no experience?
The most realistic entry path is through a provider relations coordinator or credentialing specialist role, which many DC-area managed care organizations and health systems use as a feeder into network management. CareFirst BlueCross BlueShield and AmeriHealth Caritas, both with significant DC-area operations, periodically post entry-level provider relations and data analyst roles that build directly transferable skills. Candidates coming from healthcare billing, medical office management, or health plan customer service have a natural lateral path. A Certified Provider Credentialing Specialist credential or coursework in health administration from a DC-area university such as George Washington University gives candidates a measurable edge.
Where can I find and apply to provider network management jobs in District of Columbia?
You can find and apply to provider network management jobs in District of Columbia on Migrate Mate, which lists current openings in the DC area. Search by role and location to see what is available, review the listings that fit your background, and apply directly to the ones that match your experience and career stage.
See All 36 Provider Network Management Jobs in District of Columbia
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