Payor Contract Manager (Specialty Pharmacy)
Core
Manage 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
Senior IC payor contract manager (specialty pharmacy)
Builds
Standardized and approved processes for contract implementation, maintenance, monitoring, and renewal activities
Domain
Healthcare + Commercial/Medicare/Medicaid payor contracting
Required skills
Payor contract lifecycle management, Reimbursement methodology analysis, Contract compliance (CMS/Medicaid), Financial reporting, Billing system configuration, Regulatory knowledge
Preferred skills
None stated
Technologies
Pharmacy systems, Billing platforms, Claim adjudication logic, NDC, J-codes, Modifiers
Responsibilities
Manage the lifecycle of payor contracts including review, interpretation, implementation, amendments, and renewals. Analyze reimbursement methodologies and identify risks or underpayments. Partner with finance to resolve reimbursement discrepancies 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.
Seniority
Senior, hands-on IC