Payor Contract Manager (Infusion) - BioPlus Specialty Pharmacy
Core
Manages the operational management, analysis, and administration of payor contracts for specialty pharmacy, home infusion, and ambulatory infusion services to optimize reimbursement and ensure compliance.
Role type
Senior IC payor contract manager (infusion)
Builds
Standardized and approved processes for contract implementation, maintenance, monitoring, and renewal across commercial, Medicare, and Medicaid lines of business.
Domain
Healthcare + Specialty Pharmacy/Infusion + Payor Contracting
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, system configuration for billing logic, stakeholder partnership
Preferred skills
None stated
Technologies
Pharmacy systems, billing platforms, claim adjudication logic, NDC, J-codes, modifiers, BIN/PCN, NCPDP, NPI, taxonomy configurations
Responsibilities
Manage the lifecycle of payor contracts including review, interpretation, implementation, amendments, and renewals; Analyze reimbursement methodologies to identify risks, underpayments, and revenue leakage; Partner with finance and revenue cycle 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 including CMS and anti-kickback requirements; Serve as the primary contract resource for internal teams and provide contract education.
Seniority
Senior, hands-on IC