Payor Contract Manager, Infusion
Core
Manages the operational management, analysis, and administration of payor contracts supporting specialty pharmacy, home infusion, and ambulatory infusion services to optimize reimbursement and ensure compliance.
Role type
Payor Contract Manager
Builds
Operational contract implementation, maintenance, monitoring, and renewal activities for commercial, Medicare, and Medicaid lines of business
Domain
Healthcare / Specialty Pharmacy / Infusion Services / Managed Care
Deliverable
production ML models | product features | dashboards & analysis | client delivery | infrastructure | physical/clinical work
Required skills
Payor contract lifecycle management, reimbursement methodology analysis (AWP, WAC, ASP, MAC, per diem, case rates), contract compliance (CMS, Medicare, Medicaid, 340B), financial reporting, IT system configuration for billing logic, payor mapping (BIN/PCN, NCPDP, NPI)
Preferred skills
None stated
Technologies
Pharmacy systems, billing platforms, claim adjudication logic tools
Responsibilities
Manage the lifecycle of payor contracts including review, interpretation, implementation, amendments, and renewals; Analyze reimbursement methodologies and identify risks or revenue leakage; Partner with finance to resolve payment disputes and support forecasting; Translate contract terms into operational requirements for pharmacy systems and billing platforms; Ensure contracts comply with federal and state regulations; Act as the primary contract resource for internal teams
Seniority
Mid-level individual contributor (5+ years experience)