Payor Contracts Lead - Specialty Pharmacy (Hybrid)

Elevance Health; Atlanta (GA); Híbrido; USD 111.000 - 167.000; Jornada completa

Descripción de la vacante

Elevance Health is seeking a Payor Contract Manager, Specialty Pharmacy, to oversee the contract lifecycle for payor contracts across commercial, Medicare, and Medicaid lines. You will analyze reimbursement methods, ensure pricing integrity, and align contract terms with billing systems and site-of-care rules.

This hybrid role requires 1–2 days in-office per week and supports cross-functional collaboration with finance, IT, and operations to optimize reimbursement and ensure compliant contract

Formación

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

Responsabilidades

• Manages the lifecycle of payor contracts, including review, implementation, amendments, and renewals.
• Analyzes reimbursement methodologies and identifies risks, underpayments, and leakage.
• Partners with finance and revenue cycle to resolve reimbursement discrepancies and support forecasting.
• Translates contract terms into pricing, billing, and claim adjudication requirements for systems.
• Supports payor mapping configurations (BIN/PCN/NPI).
• Ensures contracts comply with CMS, Medicare Part B and D, Medicaid, 340B, and anti-kickback rules.
• Acts as the primary contract resource for internal teams and supports escalations.

Conocimientos

Payor contracting

Managed care

Contract administration

Reimbursement analysis

Billing systems

Educación

Bachelor's degree

Descripción del empleo

Elevance Health is seeking a Payor Contract Manager, Specialty Pharmacy, to oversee the contract lifecycle for payor contracts across commercial, Medicare, and Medicaid lines. You will analyze reimbursement methods, ensure pricing integrity, and align contract terms with billing systems and site-of-care rules.

This hybrid role requires 1–2 days in-office per week and supports cross-functional collaboration with finance, IT, and operations to optimize reimbursement and ensure compliant contract