Hybrid Infusion Payor Contracts Manager

Elevance Health (Anthem); Grand Prairie (TX); Hybrid; USD 111,000 - 167,000; Full time

Job summary

Elevance Health is seeking a Payor Contract Manager, Infusion to oversee the lifecycle of payor contracts across specialty, home infusion, and ambulatory infusion services. The role coordinates with finance, IT, and pharmacy operations to ensure compliant pricing and timely renewals.

The position requires a Bachelor's degree and 5+ years in payor contracting within health plan environments, with a hybrid work arrangement and potential relocation considerations.

Qualifications

• Requires a Bachelor's degree in Business, Healthcare Administration, Finance, or related field.
• Minimum of 5 years of experience in payor contracting, managed care, or contract administration within specialty pharmacy, infusion pharmacy, PBM, or health plan environments.

Responsibilities

• Manages the lifecycle of payor contracts including review, interpretation, implementation, amendments, and renewals.
• Serves as subject matter expert on contract terms including reimbursement methodologies, fee schedules, carve-outs, drug-level pricing, site-of-care requirements, and network participation.
• Tracks contract expirations, renewals, and amendments to ensure uninterrupted access and compliance.
• Analyzes reimbursement methodologies (AWP, WAC, ASP, MAC, per diem, case rates, nursing fees, supplies, admin fees) and identifies reimbursement risks, underpayments, and revenue leakage.
• Partners with finance and revenue cycle to resolve reimbursement discrepancies and payment disputes and supports forecasting, margin analysis, and payor profitability reporting.
• Translates contract terms into operational requirements for pharmacy systems, billing platforms, and claim adjudication logic and coordinates with IT and pharmacy operations to ensure pricing and payor-specific rules setup.
• Supports payor mapping tied to BIN/PCN, NCPDP, NPI, and taxonomy configurations.
• Ensures contracts comply with federal and state regulations including CMS, Medicare Part B and D, Medicaid, 340B, and anti-kickback requirements; maintains audit-ready documentation; and supports audits.
• Acts as the primary contract resource for internal teams; provides contract education to support accurate billing and payor compliance; supports payor escalations, access issues, and network participation inquiries.

Skills

Payor contracting experience

Education

Bachelor's degree in Business, Healthcare Administration, Finance, or related field

Job description

Elevance Health is seeking a Payor Contract Manager, Infusion to oversee the lifecycle of payor contracts across specialty, home infusion, and ambulatory infusion services. The role coordinates with finance, IT, and pharmacy operations to ensure compliant pricing and timely renewals.

The position requires a Bachelor's degree and 5+ years in payor contracting within health plan environments, with a hybrid work arrangement and potential relocation considerations.