Payor Contract Manager - Infusion

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 (AWP, WAC, ASP, MAC, per diem, case rates, nursing fees, supplies, admin fees) 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, billing platforms, and claim adjudication logic and coordinates with IT and pharmacy operations to ensure accurate setup of pricing and payor-specific rules (including NDC requirements, J-codes, modifiers, and site-of-care billing logic). Supports payor mapping tied to BIN/PCN, NCPDP, NPI, and taxonomy configurations. Ensures contracts comply with federal and state regulations including CMS, Medicare Part B and D, Medicaid, 340B, and anti-kickback requirements; maintains audit-ready documentation; and supports internal/external audits. Acts as the primary contract resource for internal teams; provides contract education to support accurate billing and payor compliance; and supports payor escalations, access issues, and network participation inquiries. 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 Core Competencies Demonstrates expertise in managing payor contracts, including compliance with federal and state regulations, reimbursement methodologies, and operational requirements for pharmacy systems. Proven ability to analyze reimbursement risks and collaborate with finance and revenue cycle teams to resolve discrepancies and support profitability. Highest-signal resume keywords Payor Contract Management Reimbursement Methodologies Analysis Compliance with CMS and Medicare Regulations Pharmacy Systems Integration Contract Education and Support Hard Skills Contract Lifecycle Management Reimbursement Methodologies Fee Schedules Revenue Cycle Management Data Analysis Operational Requirements Translation Audit Documentation Contract Interpretation Risk Identification Payment Dispute Resolution Soft Skills Collaboration Communication Problem-Solving Education and Training Attention to Detail Industry Keywords Managed Care Specialty Pharmacy Infusion Pharmacy PBM Health Plan 340B Compliance Anti-Kickback Regulations NDC Requirements J-Codes Modifiers Tools & Technologies Pharmacy Systems Billing Platforms Claim Adjudication Logic IT Coordination Payor Mapping Tools #J-18808-Ljbffr Jobtailor