Payor Contract Manager – Infusion
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Posted: 10/21/2026Payor Contract Manager – Infusion
Elevance HealthCore Competencies
Role fitCore 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 optimize payor profitability.
Highest-signal resume keywords
Payor Contract ManagementReimbursement MethodologiesPharmacy Systems KnowledgeFederal And State Regulations ComplianceContract Administration Experience
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 and reimbursement methodologies
- Track contract expirations, renewals, and amendments
- Analyze reimbursement methodologies and identify reimbursement risks, underpayments, and revenue leakage
- Partner with finance and revenue cycle teams 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 for BIN/PCN, NCPDP, NPI, and taxonomy configurations
- Ensure contract compliance with federal and state regulations and maintain audit-ready documentation
- Support internal and external audits
- Provide contract education to internal teams to support accurate billing and payor compliance
- 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
- Minimum of 5 years of experience in payor contracting, managed care, or contract administration within specialty pharmacy, infusion pharmacy, PBM, or health plan environments
- Experience or equivalent combination of education and experience providing an equivalent background
- Knowledge of reimbursement methodologies including AWP, WAC, ASP, MAC, per diem, case rates, nursing fees, supplies, and administrative fees
- Knowledge of payor contract terms, reimbursement methodologies, fee schedules, carve-outs, drug-level pricing, site-of-care requirements, and network participation
- Knowledge of pharmacy systems, billing platforms, claim adjudication logic, NDC requirements, J-codes, modifiers, and site-of-care billing logic
- Knowledge of payor mapping tied to BIN/PCN, NCPDP, NPI, and taxonomy configurations
- Knowledge of federal and state regulations including CMS, Medicare Part B and D, Medicaid, 340B, and anti-kickback requirements
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) with match
- Stock purchase plan
- Life insurance
- Wellness programs
- Financial education resources
- Hybrid work flexibility
- COVID-19 and Influenza vaccination accommodation process where applicable
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Contract ReviewReimbursement AnalysisForecastingMargin AnalysisPayor Profitability ReportingClaim Adjudication LogicNDC RequirementsJ-CodesModifiersSite-Of-Care Billing Logic
Soft Skills
CollaborationCommunicationProblem-SolvingEducation And Training
Tools & Technologies
Billing PlatformsPharmacy SystemsIT Coordination
Industry Keywords
Managed CareSpecialty PharmacyInfusion PharmacyPBMHealth PlanCMSMedicareMedicaid340BAnti-Kickback Requirements