Payor Contract Lead, Specialty Pharmacy

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

Job summary

Elevance Health is seeking a Payor Contract Manager (Specialty Pharmacy) to lead contract lifecycle management for specialty pharmacy, home infusion and ambulatory infusion services.

In this hybrid role, you will review, interpret, implement, amend, and renew payor contracts; serve as SME on reimbursement methodologies; track expirations; collaborate with finance, IT, and operations to ensure accurate pricing and compliant payor rules; and support audits and payor mapping.

Qualifications

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

Responsibilities

• Manage lifecycle of payor contracts including review, interpretation, implementation, amendments, and renewals.
• Serve as SME on contract terms incl. reimbursement methodologies, fee schedules, site-of-care, and network participation.
• Track expirations, renewals and amendments to ensure access and compliance.
• Analyze reimbursement methodologies and identify risks, underpayments, and leakage.
• Coordinate with finance, IT and operations to ensure pricing accuracy and payor-specific rules.

Skills

Payor contracting

Managed care

Contract administration

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 lead contract lifecycle management for specialty pharmacy, home infusion and ambulatory infusion services.

In this hybrid role, you will review, interpret, implement, amend, and renew payor contracts; serve as SME on reimbursement methodologies; track expirations; collaborate with finance, IT, and operations to ensure accurate pricing and compliant payor rules; and support audits and payor mapping.