Hybrid Payor Contract Manager, Specialty Pharmacy

The Elevance Health Companies, Inc.; Grand Prairie (TX); Hybrid; USD 111,000 - 167,000; Full time

Job summary

Elevance Health invites applications for a Payor Contract Manager (Specialty Pharmacy) role. The position oversees contract lifecycle, reimbursement methods, and network participation, ensuring regulatory compliance across CMS, Medicare, and Medicaid programs.

The hybrid role focuses on optimizing payor profitability and accurate pricing setup. The ideal candidate has a Bachelor's degree in a related field and at least 5 years in payor contracting or contract administration within specialty PBM

Qualifications

• 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.

Skills

Payor contracting

Contract management

Reimbursement methodologies

CMS knowledge

Data analysis

Education

Bachelor's degree in Business/Healthcare/Finance

Tools

Billing platforms

Pharmacy systems

NDC requirements

Job description

Elevance Health invites applications for a Payor Contract Manager (Specialty Pharmacy) role. The position oversees contract lifecycle, reimbursement methods, and network participation, ensuring regulatory compliance across CMS, Medicare, and Medicaid programs.

The hybrid role focuses on optimizing payor profitability and accurate pricing setup. The ideal candidate has a Bachelor's degree in a related field and at least 5 years in payor contracting or contract administration within specialty PBM