Hybrid Payor Contract Leader, Specialty Pharmacy

Elevance Health, Inc.; Nashville (TN); Híbrido; USD 111.000 - 167.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Hybrid work model

Descripción de la vacante

Elevance Health, Inc. is seeking a Payor Contract Manager (Specialty Pharmacy) to oversee the operational management, analysis, and administration of payor contracts across commercial, Medicare, and Medicaid lines.

This hybrid role requires in-office presence 1–2 days per week and offers options for nearby locations within commuting distance. You will manage contract lifecycles, interpret terms, analyze reimbursement methodologies, and collaborate with finance to resolve discrepancies, ensuring

Formación

• Requires a Bachelor’s degree in Business, Healthcare Administration, Finance, or related field and minimum of 5 years of experience in payor contracting, managed care, or contract administration within specialty pharmacy, infusion pharmacy, PBM, or health plan environments; or any combination of education and experience which would provide an equivalent background.

Responsabilidades

• 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 accurate setup of pricing and payor-specific rules (including NDC requirements, J-codes, modifiers, and site-of-care billing logic).
• 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 internal/external audits.
• Acts as the primary contract resource for internal teams; provides contract education to support accurate billing and payor compliance; and supports payor escalations, access issues, and network participation inquiries.

Conocimientos

Contract management

Healthcare reimbursement knowledge

Regulatory compliance awareness

Educación

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

Herramientas

Contract management systems

Descripción del empleo

Elevance Health, Inc. is seeking a Payor Contract Manager (Specialty Pharmacy) to oversee the operational management, analysis, and administration of payor contracts across commercial, Medicare, and Medicaid lines.

This hybrid role requires in-office presence 1–2 days per week and offers options for nearby locations within commuting distance. You will manage contract lifecycles, interpret terms, analyze reimbursement methodologies, and collaborate with finance to resolve discrepancies, ensuring