Payer Contracting Manager- Evernorth- Hybrid

Cigna Healthcare

1d•Hybrid

About The Position

Under the general direction of the Managing Director, the Payor Contracting Manager provides guidance to stakeholders on payer contract information. This role is for an individual that will excel in a mix of executive-facing and transformational project-focused responsibilities. This Payer Contracting Manager will be responsible for building and maintaining a knowledge base of home infusion contract reimbursement information and using that subject matter expertise to advise CarePathRx’s growing number of health system partners. This role will provide industry knowledge and support to drive the best outcomes for the system. This role will serve as a liaison and strategic partner to client leadership and internal stakeholders, ensuring alignment between strategy, payer requirements, operational execution, and financial outcomes.

Requirements

Knowledge of HIPAA guidelines, federal, state, and local regulations related to pharmacy or healthcare providers.
Operational knowledge to translate contractual language into successful implementation with teams.
Expertise in building strong relationships with regional and national payors and health system clients in the managed care and leadership arena.
Ability to manage multiple priorities.
Ability to work independently and execute deadlines effectively.
Proficiency in Microsoft Excel, Microsoft Word, and PowerPoint.
High School Diploma or GED required.
Demonstrated 10+ years of payer or contract management experience in specialty pharmacy and/or infusion therapy required.
Advanced knowledge of health insurance plans: Managed Care Organizations, PPO, POS, Self-Funded, TPAs and providers at financial risk (hospital/health systems, medical group/IPA).
Strong understanding of healthcare billing, reimbursement, regulatory requirements, and financial controls.
Strategic, analytical mindset with the ability to balance long‑term vision and operational outcomes.

Nice To Haves

Bachelor’s degree in finance, Accounting, Business Administration, or related field highly desired.
Experience with CPR +, CareTend, HCN EMR systems preferred.

Responsibilities

Develop payor priorities for securing contracts.
Review payor contracts and related amendments and providing related recommendations.
Evaluate and analyze proposed rates against benchmarks, including per diem and drug rates.
Provide partner guidance during health system implementation of their home infusion pharmacy for the health system partner and CarePathRx, including aligning all processes to the overall implementation timelines, including payor credentialing application process.
Provide consultation, education and training on contract requirements to Intake and Billing/Collection teams, including information regarding payor reimbursement methodologies, rates and policies.
Work cross-functionally to ensure contract or amended rates and payor information is loaded accurately by the appropriate team for system optimization.
Maintain the knowledgebase particular to benchmark rates and managed care terms; leverage this data to inform health system partner strategies.
Manage payor contracts and amending reference materials to support all teams.
Liaise with internal and external teams when needed for resolution of payer processing issues around payer contract load issues.
Set the strategic direction for payer contract management, ensuring contracts are operationalized effectively to support accurate benefit verification, billing, and collections.
Oversee payer change management strategy, including prioritization, risk mitigation, and cross‑functional coordination for payer updates across the client base.
Provide executive oversight for payer audits, ensuring timely, compliant, and effective responses while identifying systemic improvement opportunities.
Define cadences for review of contracting pricing and support on best practices to move forward optimizing outcomes and results.
Serve as a trusted advisor to client executives and internal leadership, translating payer performance into strategic insights and recommendations.
Foster strong cross‑functional relationships to align operations and partner managed care teams for payer engagement strategies.