Hybrid Payor Contract Manager, Specialty Pharmacy

Elevance Health, Inc.; Winston-Salem (NC); Hybrid; USD 111,000 - 167,000; Full time

Job summary

Elevance Health, Inc. is seeking a Payor Contract Manager for Specialty Pharmacy to lead contract lifecycle, reimbursement analysis, and compliance across commercial, Medicare, and Medicaid lines. This role combines in-office collaboration 1-2 days per week with remote work flexibility.

You will translate contract terms into operational requirements for pharmacy systems, support payor mapping, and collaborate with finance and IT to ensure accurate pricing and proper billing rules.

Qualifications

• Bachelor’s degree in Business, Healthcare Administration, Finance, or related field.
• At least 5 years of experience in payor contracting or contract administration in specialty pharmacy, infusion pharmacy, PBM, or health plan environments or equivalent combination of education and experience.

Responsibilities

• Manage lifecycle of payor contracts: review, interpretation, implementation, amendments, renewals.
• Serve as SME on contract terms: reimbursement methods, fee schedules, drug pricing, site-of-care rules.
• Track expirations and renewals to ensure access and compliance.
• Analyze reimbursement methods (AWP, WAC, ASP, MAC) and identify risks.
• Collaborate with finance to resolve reimbursement discrepancies and support forecasting and profitability reporting.
• Translate contract terms into pricing rules for pharmacy systems and billing.
• Support payor mapping tied to BIN/PCN, NCPDP, NPI, and taxonomy configurations.
• Ensure contracts comply with CMS, Medicare Part B and D, Medicaid, 340B, and anti-kickback requirements.

Skills

Contract management

Payor contracting

Reimbursement analysis

Cross-functional collaboration

Education

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

Job description

Elevance Health, Inc. is seeking a Payor Contract Manager for Specialty Pharmacy to lead contract lifecycle, reimbursement analysis, and compliance across commercial, Medicare, and Medicaid lines. This role combines in-office collaboration 1-2 days per week with remote work flexibility.

You will translate contract terms into operational requirements for pharmacy systems, support payor mapping, and collaborate with finance and IT to ensure accurate pricing and proper billing rules.