Payor Contract Manager – Infusion

Elevance Health

Payor Contract Manager managing the lifecycle of payor contracts for BioPlus Specialty Pharmacy. Requires 5 years of experience and a Bachelor’s degree in a related field.

Posted 7/22/2026full-timeGrand Prairie • Florida, Louisiana, North Carolina, Ohio, Texas • 🇺🇸 United StatesMid-LevelSenior💰 $111,132 - $166,698 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in managing payor contracts, including compliance with federal and state regulations, reimbursement methodologies, and operational requirements for pharmacy systems. Proven ability to analyze reimbursement risks and collaborate with finance and revenue cycle teams to resolve discrepancies and support profitability.

Highest-signal resume keywords

Payor Contract ManagementReimbursement Methodologies AnalysisCompliance with CMS and Medicare RegulationsPharmacy Systems IntegrationContract Education and Support

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Contract Lifecycle ManagementReimbursement MethodologiesFee SchedulesRevenue Cycle ManagementData AnalysisOperational Requirements TranslationAudit DocumentationContract InterpretationRisk IdentificationPayment Dispute Resolution

Soft Skills

CollaborationCommunicationProblem-SolvingEducation and TrainingAttention to Detail

Tools & Technologies

Pharmacy SystemsBilling PlatformsClaim Adjudication LogicIT CoordinationPayor Mapping Tools

Industry Keywords

Managed CareSpecialty PharmacyInfusion PharmacyPBMHealth Plan340B ComplianceAnti-Kickback RegulationsNDC RequirementsJ-CodesModifiers

About the role

Key responsibilities & impact

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.

Requirements

What you’ll need

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

Benefits

Comp & perks

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