Payor Contract Manager, Infusion

Elevance Health is a leading health company dedicated to improving lives and communities by making healthcare simpler and more accessible. As a Fortune 25 company with a storied history in the healthcare industry, Elevance Health drives innovation and positive impact through its commitment to members, communities, and associates. With a culture rooted in core values and behaviors, the company promotes personal and professional growth for its workforce while striving to achieve strategic business outcomes. Elevance Health offers a Hybrid Workforce Strategy that blends structured office presence with the flexibility of virtual work, requiring employees to work at an Elevance Health location at least once per week, supporting a dynamic and adaptable workplace environment. Comprehensive benefits including merit increases, paid holidays, medical and dental insurance, wellness programs, and financial education are part of their competitive total rewards package.

The Payor Contract Manager, Infusion at Elevance Health plays a critical role in the operational management, analysis, and administration of payor contracts that support specialty pharmacy, home infusion, and ambulatory infusion services. This position ensures that all contract implementation, maintenance, monitoring, and renewal activities adhere to standardized and approved procedures, optimizing reimbursement and maintaining compliance. The role's primary focus is on the commercial, Medicare, and Medicaid lines of business, with an emphasis on driving sustainable growth and mitigating financial risks through proactive contract management. The Payor Contract Manager serves as the subject matter expert on contract terms—such as reimbursement methodologies, fee schedules, drug-level pricing, site-of-care requirements, and network participation—and oversees the entire lifecycle of payor contracts including review, interpretation, amendments, and renewals.

Responsibilities also include analyzing complex reimbursement methodologies such as AWP, WAC, ASP, and MAC to identify risks, underpayments, and revenue leakage. This manager collaborates closely with finance and revenue cycle teams to resolve discrepancies, support forecasting, and provide payor profitability reporting. Additionally, the role involves translating contract terms into operational requirements for pharmacy systems, billing platforms, and claims adjudication logic. Coordination with IT and pharmacy operations ensures accurate setup of pricing and payor-specific rules, including National Drug Code (NDC) requirements, J-codes, modifiers, and site-of-care billing logic. The Payor Contract Manager supports payor mapping tied to BIN/PCN, NCPDP, NPI, and taxonomy configurations while ensuring federal and state regulation compliance—including CMS, Medicare Part B and D, Medicaid, 340B, and anti-kickback statutes. Maintaining audit-ready documentation and supporting internal and external audits are integral.

This position also acts as a primary resource for internal teams by providing contract education that supports accurate billing and payor compliance. The Payor Contract Manager addresses payor escalations, access issues, and network participation inquiries to maintain seamless contract management and adherence to regulatory requirements. The role requires a combination of sharp analytical skills, comprehensive knowledge of healthcare payor contracts, and the ability to collaborate with cross-functional teams in a hybrid work environment that encourages innovation and flexibility.