Remote Payer Contracting Leader (Strategic Advisor)

Evernorth Health Services; United States; Hybrid; USD 104,000 - 173,000; Full time

Benefits offered by this job

Annual bonus plan

Comprehensive benefits package

Job summary

Evernorth is seeking a Contract Senior Advisor to lead payer contracting strategy and execution, focusing on home infusion contract reimbursement. The role collaborates with executives and health system partners, translating complex contract terms into actionable guidance and optimizing reimbursement outcomes.

You will drive governance, manage relationships with payors, and oversee implementation efforts across care pathways while leveraging industry knowledge to improve system performance.

Qualifications

• 8+ years of payer or contract management experience in specialty pharmacy and/or infusion therapy required
• Advanced knowledge of health insurance plans: Managed Care Organizations, PPO, POS, Self-Funded, TPAs and providers at financial risk
• Strong understanding of healthcare billing, reimbursement, regulatory requirements, and financial controls
• Strategic, analytical mindset with the ability to balance long-term vision and operational outcomes

Responsibilities

• Develop payor priorities for securing contracts and reviewing payor contracts with amendments
• Evaluate proposed rates against benchmarks (per diem and drug rates)
• Guide health system implementation of home infusion pharmacy and ensure accurate load of payor information
• Provide consultation and training on contract requirements to Intake and Billing/Collections teams
• Maintain knowledgebase on benchmark rates and managed care terms to inform partner strategies
• Oversee payer contract management and reference materials; coordinate cross-functional resolution of issues
• Set strategic direction for payer contract management to support accurate benefit verification, billing, and collections
• Define cadence for contracting pricing reviews and share best practices to improve outcomes
• Serve as trusted advisor to client executives translating payer performance into strategic insights
• Foster cross-functional relationships to align operations for payer engagement strategies

Skills

HIPAA knowledge

Regulatory knowledge

Payor relationships

Multitasking

Independence

Excel

Word

PowerPoint

CPR+

CareTend

HCN EMR

Education

High School Diploma or GED

Bachelor’s degree in finance, accounting, business administration, or related field

Tools

CPR+

CareTend

HCN EMR

Job description

Evernorth is seeking a Contract Senior Advisor to lead payer contracting strategy and execution, focusing on home infusion contract reimbursement. The role collaborates with executives and health system partners, translating complex contract terms into actionable guidance and optimizing reimbursement outcomes.

You will drive governance, manage relationships with payors, and oversee implementation efforts across care pathways while leveraging industry knowledge to improve system performance.