Payor Contract Manager, Infusion

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 and supports forecasting, margin analysis, and payor profitability reporting
• Translates contract terms into operational requirements for pharmacy systems and coordinates with IT and pharmacy operations
• Supports payor mapping tied to BIN/PCN, NCPDP, NPI, and taxonomy configurations
• Ensures contracts comply with federal and state regulations and supports internal/external audits

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

Benefits

• Health insurance
• 401(k) +match
• Paid Time Off
• Incentive bonus programs
• Stock purchase plan
• Life insurance
• Wellness programs
• Financial education resources