Strategic Payor Contract Manager, Specialty Pharmacy

Elevance Health; Texas; Hybrid; USD 111.000 - 167.000; Vollzeit

Benefits dieser Stelle

Hybrid work model

Zusammenfassung

Elevance Health is seeking a Payor Contract Manager for Specialty Pharmacy to oversee contract lifecycle, analyze reimbursement, and ensure compliant pricing across commercial, Medicare, and Medicaid.

Hybrid role requiring in-office 1-2 days weekly; alternate locations within commuting distance may be considered. You will translate contract terms into pricing rules and support audits of payor networks.

Qualifikationen

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

Aufgaben

• Manages the lifecycle of payor contracts including review, interpretation, implementation, amendments, and renewals.
• Serves as subject matter expert on contract terms including reimbursement methodologies, fee schedules, carve-outs, drug-level pricing, site-of-care requirements, and network participation.
• Tracks contract expirations, renewals, and amendments to ensure uninterrupted access and compliance.
• Analyzes reimbursement methodologies (AWP, WAC, ASP, MAC, per diem, case rates, nursing fees, supplies, admin fees) and identifies reimbursement risks, underpayments, and revenue leakage.
• Partners with finance and revenue cycle to resolve reimbursement discrepancies and payment disputes and supports forecasting, margin analysis, and payor profitability reporting.
• Translates contract terms into operational requirements for pharmacy systems, billing platforms, and claim adjudication logic and coordinates with IT and pharmacy operations to ensure accurate setup of pricing and payor-specific rules (including NDC requirements, J-codes, modifiers, and site-of-care billing logic).
• Supports payor mapping tied to BIN/PCN, NCPDP, NPI, and taxonomy configurations.
• Ensures contracts comply with federal and state regulations including CMS, Medicare Part B and D, Medicaid, 340B, and anti-kickback requirements; maintains audit-ready documentation; and supports internal/external audits.
• Acts as the primary contract resource for internal teams; provides contract education to support accurate billing and payor compliance; and supports payor escalations, access issues, and network participation inquiries.

Kenntnisse

Contract management

Payor contracting

Cross-functional collaboration

Regulatory compliance

Ausbildung

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

Jobbeschreibung

Elevance Health is seeking a Payor Contract Manager for Specialty Pharmacy to oversee contract lifecycle, analyze reimbursement, and ensure compliant pricing across commercial, Medicare, and Medicaid.

Hybrid role requiring in-office 1-2 days weekly; alternate locations within commuting distance may be considered. You will translate contract terms into pricing rules and support audits of payor networks.