Strategic Payor Contracts Lead — Specialty Pharmacy

Elevance Health, Inc.; Louisville (KY); Ibrido; USD 111.000 - 167.000; Tempo pieno

Descrizione del lavoro

Elevance Health, Inc. is seeking a Payor Contract Manager for Specialty Pharmacy to oversee contract lifecycle, from review to renewals, across commercial, Medicare and Medicaid lines.

The role requires translating contract terms into operational requirements for billing systems and payor rules. This hybrid position supports in-office 1-2 days per week with flexibility for alternate locations within commuting distance, and emphasizes collaboration with finance, IT, and clinical operations to

Competenze

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

Mansioni

• Manage the lifecycle of payor contracts including review, interpretation, implementation, amendments, and renewals.
• Serve as subject matter expert on contract terms including reimbursement methodologies, fee schedules, carve-outs, drug-level pricing, site-of-care requirements, and network participation.
• Track contract expirations, renewals, and amendments to ensure uninterrupted access and compliance.
• Analyze reimbursement methodologies (AWP, WAC, ASP, MAC, per diem, case rates, nursing fees, supplies, admin fees) and identify reimbursement risks, underpayments, and revenue leakage.
• Partner with finance and revenue cycle to resolve reimbursement discrepancies and payment disputes and support forecasting, margin analysis, and payor profitability reporting.
• Translate contract terms into operational requirements for pharmacy systems, billing platforms, and claim adjudication logic and coordinate with IT and pharmacy operations to ensure accurate setup of pricing and payor-specific rules.
• Support payor mapping tied to BIN/PCN, NCPDP, NPI, and taxonomy configurations.
• Ensure 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.

Conoscenze

Contract management

Payor contracting

Reimbursement analysis

Cross-functional collaboration

Contract administration

Formazione

Bachelor's degree in Business/Healthcare Administration/Finance

Descrizione del lavoro

Elevance Health, Inc. is seeking a Payor Contract Manager for Specialty Pharmacy to oversee contract lifecycle, from review to renewals, across commercial, Medicare and Medicaid lines.

The role requires translating contract terms into operational requirements for billing systems and payor rules. This hybrid position supports in-office 1-2 days per week with flexibility for alternate locations within commuting distance, and emphasizes collaboration with finance, IT, and clinical operations to