Provider Relations Representative Jobs in Virginia
Provider Relations Representative jobs in Virginia are consistently active, with demand concentrated in health insurance, managed care, and hospital systems across Northern Virginia, Richmond, and Hampton Roads. Major employers with lasting Virginia footprints include Sentara Health, Humana, and Anthem (now Elevance Health), all of which maintain provider network teams in the state. The most in-demand specialties are network credentialing, provider onboarding, and contract compliance. Scan the live roles below and apply to whichever ones fit.
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Showing 5 of 7+ Provider Relations Representative jobs
Become a part of our caring community
The Provider Relations Representative (Provider Engagement Professional) is responsible for day-to-day front line relationship management of network providers in Humana's Healthy Horizons in Virginia Medicaid network. This role supports provider onboarding, training, education, and inquiry/issue support resolution. This role specifically supports long-term services and supports (LTSS) and home and community-based services (HCBS) providers and must be based in Virginia. The individual in this role should have critical thinking/problem solving skills, understanding of health plan operations, and strong interpersonal skills.Serve as primary relationship manager with assigned LTSS and HCBS providers to ensure positive provider experience with Humana Healthy Horizons and promote network retention
Meet regularly, both in person and virtually, with assigned providers to conduct training and education, including, but not limited to, required annual trainings, periodic updates to and/or reviews of Humana policies and procedures, and Humana systems training and updates
Support newly assigned providers with onboarding, including hosting orientation session(s)
Respond to assigned provider inquiries and support prompt issue resolution, including, where necessary, collaboration with appropriate enterprise business teams (ex., claims payment, prior authorizations & referrals)
Work with internal resources and systems (e.g., claims, reimbursement, provider enrollment) to provide Exceptional Experience in all provider interactions
Create provider trainings based on provider feedback, trends in claims or process changes
Educate provider on location and content of all provider facing materials (Orientation, Provider Manual, Newsletter, Program Updates, Etc.)
Convene regular meetings with providers, including organizing agendas, materials, meeting minutes, other team members (clinical, provider engagement), to discuss key operational, clinical, and quality related topics
Educate on processes including claims submissions, recoupments, reconsiderations, authorizations, referrals, medical record management, Availity, Quality resources, and member resources
Communicate updates on Humana's policies and procedures and Cardinal Care programmatic updates
Coordinate regional provider townhalls and/or trainings
Attend Network Meetings/Conferences
Ensure compliance with all Virginia managed care contractual requirements for provider relations, such as timeframes for claims dispute resolution, provider complaints, provider inquiry response, etc
Use your skills to make an impact
Must reside in Virginia (SW region includes, Lee, Wise, Washington and Galax)
Bachelors degree OR 1 - 5 years of Health care or managed care with Provider Contracting, Network Management or Provider Relations experience
Proven planning, preparation and presenting skills, with established knowledge of reimbursement and bonus methodologies
Demonstrated ability to manage multiple projects and meet deadlines
Preferred Qualifications
Master's Degree
Proficiency in analyzing and interpreting financial trends for health care costs, administrative expenses and quality/bonus performance
Comprehensive knowledge of Medicare policies, processes and procedures
Experience with Medicaid electronic visit verification (EVV)
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
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.$59,300 - $80,900 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 Provider Relations Representative (Provider Engagement Professional) is responsible for day-to-day front line relationship management of network providers in Humana's Healthy Horizons in Virginia Medicaid network. This role supports provider onboarding, training, education, and inquiry/issue support resolution. This role specifically supports long-term services and supports (LTSS) and home and community-based services (HCBS) providers and must be based in Virginia. The individual in this role should have critical thinking/problem solving skills, understanding of health plan operations, and strong interpersonal skills.Serve as primary relationship manager with assigned LTSS and HCBS providers to ensure positive provider experience with Humana Healthy Horizons and promote network retention
Meet regularly, both in person and virtually, with assigned providers to conduct training and education, including, but not limited to, required annual trainings, periodic updates to and/or reviews of Humana policies and procedures, and Humana systems training and updates
Support newly assigned providers with onboarding, including hosting orientation session(s)
Respond to assigned provider inquiries and support prompt issue resolution, including, where necessary, collaboration with appropriate enterprise business teams (ex., claims payment, prior authorizations & referrals)
Work with internal resources and systems (e.g., claims, reimbursement, provider enrollment) to provide Exceptional Experience in all provider interactions
Create provider trainings based on provider feedback, trends in claims or process changes
Educate provider on location and content of all provider facing materials (Orientation, Provider Manual, Newsletter, Program Updates, Etc.)
Convene regular meetings with providers, including organizing agendas, materials, meeting minutes, other team members (clinical, provider engagement), to discuss key operational, clinical, and quality related topics
Educate on processes including claims submissions, recoupments, reconsiderations, authorizations, referrals, medical record management, Availity, Quality resources, and member resources
Communicate updates on Humana's policies and procedures and Cardinal Care programmatic updates
Coordinate regional provider townhalls and/or trainings
Attend Network Meetings/Conferences
Ensure compliance with all Virginia managed care contractual requirements for provider relations, such as timeframes for claims dispute resolution, provider complaints, provider inquiry response, etc
Use your skills to make an impact
Must reside in Virginia (SW region includes, Lee, Wise, Washington and Galax)
Bachelors degree OR 1 - 5 years of Health care or managed care with Provider Contracting, Network Management or Provider Relations experience
Proven planning, preparation and presenting skills, with established knowledge of reimbursement and bonus methodologies
Demonstrated ability to manage multiple projects and meet deadlines
Preferred Qualifications
Master's Degree
Proficiency in analyzing and interpreting financial trends for health care costs, administrative expenses and quality/bonus performance
Comprehensive knowledge of Medicare policies, processes and procedures
Experience with Medicaid electronic visit verification (EVV)
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
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.$59,300 - $80,900 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 7 Provider Relations Representative Jobs in Virginia
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Find JobsProvider Relations Representative Jobs by City in Virginia
Where Virginia roles are concentrated, by current openings.
Provider Relations Representative Job Market in Virginia
A snapshot from current Virginia openings, updated as new roles post.
Who's Hiring
What Virginia Employers Look For
The qualifications that appear most often in provider relations representative jobs across Virginia.
- Bachelor's degree in healthcare administration, business, or a related field required
- Two or more years of experience in provider relations or managed care contracting
- Familiarity with Virginia Medicaid and commercial insurance network requirements
- Strong knowledge of credentialing processes and provider data management systems
- Proficiency with CRM platforms and Microsoft Office suite applications
- Excellent written and verbal communication skills for provider outreach and education
Provider Relations Representative Jobs in Virginia: Frequently Asked Questions
How do you become a provider relations representative in Virginia?
Most provider relations representative roles in Virginia require a bachelor's degree in healthcare administration, business, or a related field, along with experience in a managed care or clinical operations environment. Virginia does not require a state-issued license specific to this role, but employers strongly prefer candidates familiar with Virginia Medicaid managed care guidelines and the state's credentialing landscape. Completing a healthcare administration certification through an accredited program adds a competitive edge.
Which companies hire provider relations representatives in Virginia?
Employers hiring provider relations representatives in Virginia right now include Humana, General Dynamics Information Technology, and Blossom ABA Therapy, based on current listings on Migrate Mate as of August 2026. Virginia's concentration of large health plans and integrated delivery networks, particularly in Northern Virginia and the Richmond corridor, keeps demand for this role steady throughout the year.
Which Virginia cities have the most provider relations representative jobs?
Falls Church, Virginia, and Galax have the most provider relations representative openings in Virginia. Northern Virginia's density of health plan regional offices and government health contractors drives the heaviest hiring, while Richmond's role as the state capital anchors Medicaid managed care operations, and Hampton Roads benefits from large integrated health systems like Sentara Health that maintain active provider network teams.
Are there remote provider relations representative jobs in Virginia?
Yes, and more than many healthcare roles, because provider relations work is primarily desk-based, involving outreach, data management, and contract communication rather than hands-on clinical duties. About 100% of provider relations representative openings tied to Virginia are remote or hybrid as of August 2026, reflecting the administrative nature of the role. Provider education and onboarding tasks are the most frequently performed remotely.
How can I get hired as a provider relations representative in Virginia with little or no experience?
The most realistic entry path is moving from a provider services call center or medical billing coordinator role at a Virginia health plan or hospital system. Large employers like Sentara Health and Elevance Health's Virginia operations regularly post entry-level provider services associate positions that do not require prior relations experience. A healthcare administration degree or a certified professional in healthcare quality credential strengthens an application considerably for candidates without direct experience.
Where can I find and apply to provider relations representative jobs in Virginia?
You can find and apply to provider relations representative jobs in Virginia on Migrate Mate, which lists current Virginia openings. Search the available roles, find the ones that match your background and target location, and apply directly to whichever positions fit.
See All 7 Provider Relations Representative Jobs in Virginia
Find roles in Virginia that match your experience and apply in just a few clicks.
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