Provider Network Management Jobs in West Virginia
Provider Network Management jobs in West Virginia are in steady demand, concentrated in managed care organizations, health systems, and state-funded Medicaid programs that serve a largely rural population. Charleston, Huntington, and Morgantown anchor most of the hiring, with employers like WVU Medicine, CAMC Health System, and Highmark West Virginia drawing on network professionals at coordinator, analyst, and director levels. Contract compliance, credentialing oversight, and value-based care contracting are the sub-areas seeing the most consistent openings. Find a role that fits below and apply directly.
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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 37 Provider Network Management Jobs in West Virginia
Find roles in West Virginia that match your experience and apply in just a few clicks.
Find JobsProvider Network Management Jobs by City in West Virginia
Where West Virginia roles are concentrated, by current openings.
Provider Network Management Job Market in West Virginia
A snapshot from current West Virginia openings, updated as new roles post.
Who's Hiring
- WVU Medicine12
- ST. MARY'S MEDICAL MANAGEMENT7S
- United Hospital Center5
- St Mary's HIMG2S
- Transformations Care Network2
Top Industries Hiring
- Healthcare & Medical Services17
What West Virginia Employers Look For
The qualifications that appear most often in provider network management jobs across West Virginia.
- Bachelor's degree in healthcare administration, business, or a related field required
- Experience with provider credentialing and contracting in a managed care setting
- Familiarity with West Virginia Medicaid managed care requirements and regulations
- Proficiency with provider data management systems and network adequacy tools
- Strong knowledge of value-based care arrangements and reimbursement models
- Excellent communication skills for negotiating contracts with West Virginia providers
Provider Network Management Jobs in West Virginia: Frequently Asked Questions
How do you become a provider network management in West Virginia?
Most provider network management roles in West Virginia require a bachelor's degree in healthcare administration, public health, business, or a related field, with a master's degree preferred for senior positions. There is no single state license for the role itself, but professionals working with credentialing functions often pursue the Certified Provider Credentialing Specialist credential through the National Association of Medical Staff Services. Entry candidates typically start in provider relations, credentialing coordination, or contracting support roles within health systems or managed care organizations operating under West Virginia's Medicaid program.
How much do provider network managements make in West Virginia?
Provider network managements in West Virginia earn a median of about $112,010 a year, based on May 2025 Bureau of Labor Statistics wage data, ranging from around $77,810 for the lowest 10% to over $209,090 for the top 10%. Pay rises with experience, specialty, and employer.
Which companies hire provider network managements in West Virginia?
West Virginia provider network management roles are posted by WVU Medicine, ST. MARY'S MEDICAL MANAGEMENT, and United Hospital Center and others right now, based on current listings on Migrate Mate as of July 2026. West Virginia's Medicaid managed care environment means health plans and integrated delivery networks are among the most consistent sources of openings across the state.
Which West Virginia cities have the most provider network management jobs?
Huntington, Bridgeport, and Morgantown have the most provider network management openings in West Virginia. Charleston leads as the state capital and home to major health systems and managed care plan offices, while Huntington draws on Cabell Huntington Hospital and Marshall Health, and Morgantown supports openings tied to WVU Medicine and its affiliated academic medical network.
Are there remote provider network management jobs in West Virginia?
Yes, and more than most healthcare roles. Because provider network management centers on contracting, data analysis, and credentialing rather than direct patient care, much of the work can be done remotely. About 27% of provider network management openings tied to West Virginia are remote or hybrid as of July 2026, reflecting how desk-based this function is. Roles focused on provider data integrity, contract loading, and network adequacy reporting tend to be the most remote-friendly.
How can I get hired as a provider network management in West Virginia with little or no experience?
The most realistic entry path is through a provider relations coordinator or credentialing specialist role at a West Virginia health plan or hospital system. Organizations like WVU Medicine, Highmark West Virginia, and CAMC Health System periodically hire associate-level staff in network operations who learn contracting and credentialing on the job. Completing a healthcare administration internship, earning the Certified Provider Credentialing Specialist credential while building experience, or moving laterally from a billing or utilization management role are common ways candidates without direct network management experience get their first foothold.
Where can I find and apply to provider network management jobs in West Virginia?
You can find and apply to provider network management jobs in West Virginia on Migrate Mate, which lists current openings across the state. Search the listings, find roles that match your experience and location, and apply directly to the ones that fit.
See All 37 Provider Network Management Jobs in West Virginia
Find roles in West Virginia that match your experience and apply in just a few clicks.
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