Payor Contract Manager, Specialty Pharmacy
Elevance Health
full-time
Posted on:
Location Type: Hybrid
Location: Plano • Florida • Texas • United States
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About the role
- 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 and identifies reimbursement risks, underpayments, and revenue leakage
- Partners with finance and revenue cycle to resolve reimbursement discrepancies and payment disputes
- Translates contract terms into operational requirements for pharmacy systems, billing platforms, and claim adjudication logic
- Supports payor mapping tied to configurations
- Ensures contracts comply with federal and state regulations; maintains audit-ready documentation; and supports internal/external audits
- Acts as the primary contract resource for internal teams
Requirements
- 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
- Any combination of education and experience which would provide an equivalent background
Benefits
- Merit increases
- Paid holidays
- Paid Time Off
- Incentive bonus programs
- Medical benefits
- Dental benefits
- Vision benefits
- Short and long term disability benefits
- 401(k) + match
- Stock purchase plan
- Life insurance
- Wellness programs
- Financial education resources
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
contract managementreimbursement methodologiesfee schedulesdrug-level pricingsite-of-care requirementsnetwork participationreimbursement analysisbilling platformsclaim adjudicationpayor mapping
Soft Skills
communicationproblem-solvingcollaborationanalytical thinkingattention to detailorganizational skillssubject matter expertisenegotiationinterpersonal skillsproject management