Payor Pricing Analyst (BioPlus)
Elevance Health•Tampa, FL
•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.
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.
Benefits
- merit increases
- paid holidays
- Paid Time Off
- incentive bonus programs
- medical
- dental
- vision
- short and long term disability benefits
- 401(k) +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
