Payer Contracting Manager, Home Infusion
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Job Description
Payer Contracting Manager optimizing home infusion contracts and reimbursement for Evernorth health system partners. Advising executives and leading payer strategy, implementation, audits, and change management.
Responsibilities:
- Provide guidance to stakeholders on payer contract information
- Build and maintain a knowledge base of home infusion contract reimbursement information
- Advise CarePathRx health system partners using payer contracting subject matter expertise
- Serve as liaison and strategic partner to client leadership and internal stakeholders
- Develop payer priorities for securing contracts
- Review payer contracts and amendments and provide recommendations
- Evaluate proposed per diem and drug rates against benchmarks
- Guide health system implementation of home infusion pharmacies
- Align processes with implementation timelines, including payer credentialing applications
- Provide consultation, education, and training on contract requirements, reimbursement methodologies, rates, and policies
- Coordinate cross-functionally to ensure contract, amended-rate, and payer information is accurately loaded
- Maintain benchmark-rate and managed-care-term knowledge bases
- Manage payer contracts and amend reference materials
- Resolve payer processing and contract-load issues with internal and external teams
- Set strategic direction for payer contract management and contract operationalization
- Oversee payer change management, prioritization, risk mitigation, and cross-functional coordination
- Provide executive oversight for payer audits and identify systemic improvement opportunities
- Define review cadences and best practices for contracting pricing optimization
- Advise client executives and internal leadership with strategic payer-performance insights
- Foster cross-functional relationships for payer engagement strategies
Requirements:
- High School Diploma or GED required
- Bachelor’s degree in finance, Accounting, Business Administration, or related field highly desired
- Demonstrated 8+ years of payer or contract management experience in specialty pharmacy and/or infusion therapy required
- Advanced knowledge of health insurance plans: Managed Care Organizations, PPO, POS, Self-Funded, TPAs and providers at financial risk (hospital/health systems, medical group/IPA)
- Strong understanding of healthcare billing, reimbursement, regulatory requirements, and financial controls
- Knowledge of HIPAA guidelines and federal, state, and local regulations related to pharmacy or healthcare providers
- Operational knowledge to translate contractual language into successful implementation with teams
- Expertise in building relationships with regional and national payors and health system clients in the managed care and leadership arena
- Ability to manage multiple priorities
- Ability to work independently and execute deadlines effectively
- Proficiency in Microsoft Excel, Microsoft Word, and PowerPoint
- Experience with CPR+, CareTend, and HCN EMR systems preferred
- Strategic, analytical mindset with ability to balance long-term vision and operational outcomes
- For home-based work, internet connection must be through a cable broadband or fiber optic provider with speeds of at least 10Mbps download/5Mbps upload
Benefits:
- Annual bonus plan eligibility
- Medical insurance
- Vision insurance
- Dental insurance
- Well-being and behavioral health programs
- 401(k)
- Company-paid life insurance
- Tuition reimbursement
- Minimum of 18 days of paid time off per year
- Paid holidays
- Leaves of absence
- Remote work arrangement
- Cable broadband or fiber optic internet service with minimum speeds of 10Mbps download/5Mbps upload for home-based work
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