Payor Contract Manager (Infusion) - BioPlus Specialty Pharmacy

About the role

This role requires associates to be in-office 1-2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. The Payor Contract Manager, Infusion manages the operational management, analysis, and administration of payor contracts supporting specialty pharmacy, home infusion, and ambulatory infusion services.

Responsibilities

• 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 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.
• Supports payor mapping tied to BIN/PCN, NCPDP, NPI, and taxonomy configurations.
• Ensures contracts comply with federal and state regulations and maintains audit-ready documentation.
• Acts as the primary contract resource for internal teams and provides contract education to support accurate billing and payor compliance.

Requirements

• Requires a Bachelor’s degree in Business, Healthcare Administration, Finance, or related field and minimum of 5 years of experience in payor contracting, managed care, or contract administration within specialty pharmacy, infusion pharmacy, PBM, or health plan environments.

Qualifications

The ideal candidate will have experience in payor contracting, managed care, or contract administration within specialty pharmacy, infusion pharmacy, PBM, or health plan environments.

Skills

Strong analytical and problem-solving skills, ability to work in a fast-paced environment, and excellent communication and interpersonal skills.

Benefits

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs, medical, dental, vision, short and long term disability benefits, 401(k) + match, stock purchase plan, life insurance, wellness programs and financial education resources.

Pay

Compensation: MIN $111,132 - MAX $166,698

Schedule

This role requires associates to be in-office 1-2 days per week, with the possibility of working from home or alternate locations.