Payor Contract Manager – Infusion

Elevance Health

. Manage the lifecycle of payor contracts, including review, interpretation, implementation, amendments, and renewals .

Posted 9/21/2026full-timeUnited 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. Proficient in analyzing reimbursement risks and collaborating with finance and revenue cycle teams to resolve discrepancies.

Highest-signal resume keywords

Payor ContractingReimbursement MethodologiesPharmacy Systems KnowledgeContract AdministrationSpecialty Pharmacy Experience

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Contract ManagementReimbursement AnalysisFee Schedule InterpretationOperational Requirement TranslationAudit Compliance

Tools & Technologies

Billing PlatformsClaim Adjudication LogicPharmacy Systems

Industry Keywords

Managed CareSpecialty PharmacyInfusion PharmacyPBMHealth PlanCMSMedicareMedicaid340BAnti-Kickback Requirements

About the role

Key responsibilities & impact

Manage the lifecycle of payor contracts, including review, interpretation, implementation, amendments, and renewals
Serve as subject matter expert on contract terms, reimbursement methodologies, fee schedules, carve-outs, drug-level pricing, site-of-care requirements, and network participation
Track contract expirations, renewals, and amendments
Analyze reimbursement methodologies and identify reimbursement risks, underpayments, and revenue leakage
Partner with finance and revenue cycle to resolve reimbursement discrepancies and payment disputes
Support forecasting, margin analysis, and payor profitability reporting
Translate contract terms into operational requirements for pharmacy systems, billing platforms, and claim adjudication logic
Coordinate with IT and pharmacy operations to ensure accurate pricing and payor-specific rule setup
Support payor mapping tied to BIN/PCN, NCPDP, NPI, and taxonomy configurations
Ensure contracts comply with federal and state regulations and maintain audit-ready documentation
Support internal and external audits
Act as primary contract resource for internal teams and provide contract education
Support payor escalations, access issues, and network participation inquiries

Requirements

What you’ll need

Bachelor’s degree in Business, Healthcare Administration, Finance, or related field and minimum of 5 years of experience in payor contracting, managed care, or contract administration within specialty pharmacy, infusion pharmacy, PBM, or health plan environments; or any combination of education and experience which would provide an equivalent background
Experience with payor contracting, managed care, or contract administration
Experience within specialty pharmacy, infusion pharmacy, PBM, or health plan environments
Knowledge of reimbursement methodologies including AWP, WAC, ASP, MAC, per diem, case rates, nursing fees, supplies, and administrative fees
Knowledge of pharmacy systems, billing platforms, claim adjudication logic, NDC requirements, J-codes, modifiers, and site-of-care billing logic
Knowledge of BIN/PCN, NCPDP, NPI, and taxonomy configurations
Knowledge of CMS, Medicare Part B and D, Medicaid, 340B, and anti-kickback requirements
Ability to work in-office 1-2 days per week and within a reasonable commuting distance from a posting location unless accommodation is granted by law

Benefits

Comp & perks

Merit increases
Paid holidays
Paid Time Off
Incentive bonus programs
Medical benefits
Dental benefits
Vision benefits
Short-term disability benefits
Long-term disability benefits
401(k) + match
Stock purchase plan
Life insurance
Wellness programs
Financial education resources
Hybrid work arrangement
COVID-19 and Influenza vaccination requirement support/accommodation as applicable