Payor Contract Manager (Infusion) - BioPlus Specialty Pharmacy
About The Position
The Payor Contract Manager, Infusion manages the operational administration, analysis, and oversight of payor contracts supporting specialty pharmacy, home infusion, and ambulatory infusion services. The role ensures approved, standardized processes are followed for contract implementation, maintenance, monitoring, and renewal to optimize reimbursement, maintain compliance, and support sustainable growth across commercial, Medicare, and Medicaid lines of business. This hybrid position requires associates to work in-office 1–2 days per week. Alternate locations may be considered for candidates within commuting distance of an office; candidates outside a reasonable commuting distance generally will not be considered unless an accommodation is granted as required by law.
Requirements
- Bachelor’s degree in Business, Healthcare Administration, Finance, or a related field, and at least 5 years of experience in payor contracting, managed care, or contract administration within specialty pharmacy, infusion pharmacy, PBM, or health plan environments; or an equivalent combination of education and experience.
Responsibilities
- Manage the lifecycle of payor contracts, including review, interpretation, implementation, amendments, and renewals.
- Serve as a subject matter expert on contract terms, including reimbursement methodologies, fee schedules, carve-outs, drug-level pricing, site-of-care requirements, and network participation.
- Track contract expirations, renewals, and amendments to ensure uninterrupted access and compliance.
- Analyze reimbursement methodologies, including AWP, WAC, ASP, MAC, per diem, case rates, nursing fees, supplies, and administrative fees; identify reimbursement risks, underpayments, and revenue leakage.
- Partner with finance and revenue cycle teams to resolve reimbursement discrepancies and payment disputes, and 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 setup of pricing and payor-specific rules, including NDC requirements, J-codes, modifiers, and site-of-care billing logic.
- Support payor mapping tied to BIN/PCN, NCPDP, NPI, and taxonomy configurations.
- Ensure contracts comply with federal and state regulations, including CMS, Medicare Part B and D, Medicaid, 340B, and anti-kickback requirements.
- Maintain audit-ready documentation and support internal and external audits.
- Act as the primary contract resource for internal teams and provide contract education to support accurate billing and payor compliance.
- Support payor escalations, access issues, and network participation inquiries.
Benefits
- Merit increases
- Paid holidays
- Paid Time Off
- Incentive bonus programs, unless covered by a collective bargaining agreement
- Medical benefits
- Dental benefits
- Vision benefits
- Short- and long-term disability benefits
- 401(k) with match
- Stock purchase plan
- Life insurance
- Wellness programs
- Financial education resources
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
