Hybrid Payor Contract Manager, Specialty Pharmacy

at Elevance Health

• Job title: Payor Contract Manager, Specialty Pharmacy
• Job type: Full Time
• Experience level: Mid level, Senior
• Salary: Not specified
• Degree requirement: Bachelor's Degree
• Location requirements: Hybrid, United States

About the role

• Payor Contract Manager managing contracts for specialty pharmacy, overseeing compliance and reimbursement methodologies, and supporting internal teams. Requires a bachelor’s degree and 5 years of experience in managed care.

Responsibilities

• 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
• 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

• 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
• Any combination of education and experience which would provide an equivalent background

Benefits

• merit increases
• paid holidays
• Paid Time Off
• incentive bonus programs
• medical
• dental
• vision
• short and long term disability benefits
• 401(k) +match
• stock purchase plan
• life insurance
• wellness programs
• financial education resources