Payor Pricing Analyst (BioPlus)

Hybrid 1: 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. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office. Candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

About the role

BioPlus Specialty Pharmacy is a proud member of the Elevance Health family of companies. BioPlus offers consumers and providers an unparalleled level of service that’s easy and focused on whole health. Through distinct clinical expertise, digital capabilities, and broad access to specialty medications across a wide range of conditions, we deliver an elevated experience, affordability, and personalized support throughout the consumer’s treatment journey.

The Payor Pricing Analyst (BioPlus) will support the Director of Pricing in developing, modeling, and maintaining reimbursement pricing strategies for specialty and infusion pharmacy services.

Responsibilities

• Develops and maintains financial models to evaluate reimbursement methodologies, pricing strategies, and contract performance across commercial, Medicare, and Medicaid payors.
• Analyzes reimbursement trends, fee schedules, contract terms, and financial performance to identify pricing opportunities and recommend strategies that improve financial outcomes.
• Supports contract negotiations, request for proposal responses, and strategic initiatives through reimbursement modeling, financial analysis, and risk assessments.
• Partners with finance, contracting, revenue cycle, clinical, and operational stakeholders to ensure accurate reimbursement configuration, pricing integrity, and data analysis.
• Develops reports, dashboards, and executive-level analyses that communicate reimbursement performance, pricing trends, utilization patterns, and strategic recommendations.

Requirements

• BA/BS in Finance, Economics, Healthcare Administration, or a related field and a minimum of 3 years of experience in healthcare reimbursement, pricing, specialty pharmacy, infusion services, payor contracting, or financial analytics; or any combination of education and experience which would provide an equivalent background.
• Experience performing financial modeling and advanced spreadsheet analysis.

Preferred Qualifications

• MBA or relevant advanced certification.
• Familiarity with PBM and medical benefit billing structures.
• Experience in specialty pharmacy or home/ambulatory infusion.
• Knowledge of 340B pricing impact.
• Experience with claims data analysis and reimbursement reconciliation.
• Experience with contract modeling tools or BI platforms (Power BI, Tableau, SQL).

Benefits

• Merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement).
• Medical, dental, vision, short and long term disability benefits.
• 401(k) + match, stock purchase plan, life insurance.
• Wellness programs and financial education resources.

Schedule

Elevance Health operates in a Hybrid Workforce Strategy. Associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.