Payor Contract Manager, Specialty Pharmacy

Role Overview

• Manages the lifecycle of payor contracts including review, interpretation, implementation, amendments, and renewals
• Serves as subject matter expert on contract terms including reimbursement methodologies, fee schedules, carve-outs, drug-level pricing, site-of-care requirements, and network participation
• Tracks contract expirations, renewals, and amendments to ensure uninterrupted access and compliance
• Analyzes reimbursement methodologies and identifies reimbursement risks, underpayments, and revenue leakage
• Partners with finance and revenue cycle to resolve reimbursement discrepancies and payment disputes
• Translates contract terms into operational requirements for pharmacy systems, billing platforms, and claim adjudication logic
• Supports payor mapping tied to configurations
• Ensures contracts comply with federal and state regulations; maintains audit-ready documentation; and supports internal/external audits
• Acts as the primary contract resource for internal teams

Requirements

• Bachelor’s degree in Business, Healthcare Administration, Finance, or related field
• Minimum of 5 years of experience in payor contracting, managed care, or contract administration within specialty pharmacy, infusion pharmacy, PBM, or health plan environments
• Any combination of education and experience which would provide an equivalent background

Benefits

• Merit increases
• Paid holidays
• Paid Time Off
• Incentive bonus programs
• Medical benefits
• Dental benefits
• Vision benefits
• Short and long term disability benefits
• 401(k) + match
• Stock purchase plan
• Life insurance
• Wellness programs
• Financial education resources