Hybrid Payor Contract Manager, Specialty Pharmacy

Elevance Health, Inc.; Indianapolis (IN); Hybrid; USD 111,000 - 167,000; Full time

Job summary

Elevance Health is seeking a Payor Contract Manager (Specialty Pharmacy) to oversee the contract lifecycle for payor agreements across specialty pharmacy, home infusion, and ambulatory infusion services. The role focuses on reimbursement methodologies, pricing, and network participation to optimize revenue and ensure compliance.

The position supports collaboration with finance, IT, and pharmacy operations, ensuring pricing and site-of-care rules are correctly implemented.

Qualifications

• Bachelor’s degree and minimum 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 accurate setup of pricing and payor-specific rules.
• 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.

Skills

Payor contracting

Contract management

Reimbursement knowledge

Education

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

Job description

Elevance Health is seeking a Payor Contract Manager (Specialty Pharmacy) to oversee the contract lifecycle for payor agreements across specialty pharmacy, home infusion, and ambulatory infusion services. The role focuses on reimbursement methodologies, pricing, and network participation to optimize revenue and ensure compliance.

The position supports collaboration with finance, IT, and pharmacy operations, ensuring pricing and site-of-care rules are correctly implemented.