Payor Contract Manager (Specialty Pharmacy)

Elevance Health•Durham, NC

1d•$111,132 - $166,698•Hybrid

About The Position

The Payor Contract Manager, Specialty Pharmacy manages the operational oversight, analysis, and administration of payor contracts supporting specialty pharmacy, home infusion, and ambulatory infusion services. The role ensures standardized, approved processes are used for contract implementation, maintenance, monitoring, and renewal to optimize reimbursement, ensure compliance, and support sustainable growth across commercial, Medicare, and Medicaid lines of business. This is a hybrid role requiring 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 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 a 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 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 pricing setup 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, provide contract education to support accurate billing and payor compliance, and support payor escalations, access issues, and network participation inquiries.