Payor Contracting Account Service Manager

NOBEL Women; Town of Florida, Northern (NY, KY); Hybrid; USD 110,000 - 170,000; Full time

Job summary

Elevance Health is seeking a Payor Contracting Account Service Manager for BioPlus Specialty Pharmacy. You will manage payor and PBM contract relationships, oversee contract implementation, and optimize reimbursement and access for complex therapies.

You will analyze contract performance, resolve escalated client issues, and partner with pharmacy, clinical, and analytics teams to improve outcomes. Strong healthcare contracting experience and financial acumen are essential.

Qualifications

• Healthcare contracting experience in payor or PBM environments.
• Financial acumen with ability to model contracts.
• Experience leading cross-functional initiatives in healthcare and payer operations.

Responsibilities

• Manage payor and PBM contracting relationships for BioPlus Specialty Pharmacy.
• Oversee implementation and administration of specialty pharmacy contracts.
• Monitor contract performance, reimbursement, and pricing to drive outcomes.
• Analyze data and prepare reports on utilization, margin, and compliance for internal stakeholders.
• Resolve escalated client and payor issues with high service quality.

Skills

Healthcare contracting experience

Financial acumen

Cross-functional leadership

Education

Bachelor's degree in business/healthcare administration/finance

MBA or related master's degree (preferred)

CPhT or managed care/contracting certifications (preferred)

Tools

Excel/BI tools

Job description

Job Overview

Elevance Health seeks a Payor Contracting Account Service Manager for its BioPlus Specialty Pharmacy. In this role you will manage payor and PBM contract relationships, ensure compliant implementation of specialty pharmacy agreements, and optimize reimbursement and access for complex therapies. You will analyze contract performance, resolve escalated client issues, and partner with pharmacy, clinical, and analytics teams to improve outcomes. Ideal candidates bring strong healthcare contracting experience, financial acumen, and the ability to lead cross-functional initiatives in a mission-driven, inclusive environment.

Key Responsibilities

• Manage and maintain payor and PBM contracting relationships for BioPlus Specialty Pharmacy
• Oversee implementation and ongoing administration of specialty pharmacy contracts
• Monitor contract performance, reimbursement, and pricing to drive financial and clinical outcomes
• Analyze data and prepare reports on utilization, margin, and compliance for internal stakeholders
• Resolve escalated client and payor issues, ensuring high service quality and satisfaction
• Collaborate with pharmacy, clinical, finance, and analytics teams to improve contract value and patient access
• Support contract negotiations, renewals, and RFP responses with financial and operational insights
• Ensure adherence to regulatory, legal, and compliance requirements in all contract activities
• Identify opportunities to streamline processes and enhance specialty pharmacy programs
• Contribute to a mission-driven, inclusive culture that supports continuous learning and improvement

Key Areas

• Payor contract management
• PBM and specialty pharmacy operations
• Healthcare reimbursement analysis
• Contract negotiation support
• Account management
• Financial modeling and forecasting
• Regulatory and compliance knowledge (healthcare)
• Data analysis and reporting (Excel/BI tools)
• Cross-functional project management
• Stakeholder and client relationship management

Benefits

• Medical Insurance
• Dental Insurance
• Vision Insurance
• Life Insurance
• 401k

Education & Credentials

• Bachelor’s degree in business, healthcare administration, finance, or related field
• Preferred: MBA or related master’s degree
• Preferred: Certified Pharmacy Technician (CPhT) or managed care/contracting certifications