Payor Pricing Analyst (BioPlus)

Elevance Health•Lake Mary, FL

6d•Hybrid

About The Position

The Payor Pricing Analyst (BioPlus) will support the Director of Pricing in developing, modeling, and maintaining reimbursement pricing strategies for specialty and infusion pharmacy services. This role is responsible for financial modeling, contract analytics, and reimbursement analysis across commercial, Medicare, and Medicaid payors. This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office. BioPlus Specialty Pharmacy is a proud member of the Elevance Health family of companies. BioPlus offer consumers and providers an unparalleled level of service that’s easy and focused on whole health. Through our distinct clinical expertise, digital capabilities, and broad access to specialty medications across a wide range of conditions, we deliver an elevated experience, affordability, and personalized support throughout the consumer’s treatment journey.

Requirements

Requires a BA/BS in Finance, Economics, Healthcare Administration, or a related field and a minimum of 3 years of experience in healthcare reimbursement, pricing, specialty pharmacy, infusion services, payor contracting, or financial analytics; or any combination of education and experience which would provide an equivalent background.
Requires experience performing financial modeling and advanced spreadsheet analysis.

Nice To Haves

MBA or relevant advanced certification preferred.
Familiarity with PBM and medical benefit billing structures.
Experience in specialty pharmacy or home/ambulatory infusion.
Knowledge of 340B pricing impact.
Experience with claims data analysis and reimbursement reconciliation.
Experience with contract modeling tools or BI platforms (Power BI, Tableau, SQL).

Responsibilities

Develops and maintains financial models to evaluate reimbursement methodologies, pricing strategies, and contract performance across commercial, Medicare, and Medicaid payors.
Analyzes reimbursement trends, fee schedules, contract terms, and financial performance to identify pricing opportunities and recommend strategies that improve financial outcomes.
Supports contract negotiations, request for proposal responses, and strategic initiatives through reimbursement modeling, financial analysis, and risk assessments.
Partners with finance, contracting, revenue cycle, clinical, and operational stakeholders to ensure accurate reimbursement configuration, pricing integrity, and data analysis.
Develops reports, dashboards, and executive-level analyses that communicate reimbursement performance, pricing trends, utilization patterns, and strategic recommendations.