Payer Contracting Manager, Home Infusion

This is a fully remote position, open to applicants in United States.

📋 Description

• Collaborate with CarePathRx’s health system partners to enhance contracts for their home infusion pharmacy.

• Establish payor priorities to secure contracts effectively.

• Analyze payor contracts and associated amendments while offering relevant recommendations.

• Assess and interpret proposed rates against established benchmarks.

• Ensure all processes align with the overall implementation timelines.

• Offer consultation, education, and training regarding contract requirements to the Intake and Billing/Collection teams.

• Work collaboratively across departments to guarantee accurate loading of contract or amended rates.

• Maintain a knowledgebase specifically related to benchmark rates.

• Manage payor contracts and update reference materials as necessary.

• Provide executive oversight for payer audits.

• Establish regular review processes for contracting pricing and support best practices.

⛳️ Requirements

• High School Diploma or GED is required.

• Bachelor’s degree in finance, Accounting, Business Administration, or a related field is highly preferred.

• A minimum of 8 years of payer or contract management experience in specialty pharmacy and/or infusion therapy is required.

• Advanced understanding of health insurance plans, including Managed Care Organizations, PPO, POS, Self-Funded, TPAs, and providers at financial risk (hospital/health systems, medical group/IPA).

• Strong grasp of healthcare billing, reimbursement, regulatory requirements, and financial controls.

• Possess a strategic, analytical mindset capable of balancing long-term vision with operational outcomes.

🏝️ Benefits

• Medical, vision, dental, and well-being and behavioral health programs.

• 401(k).

• Company-paid life insurance.

• Tuition reimbursement.

• A minimum of 18 days of paid time off per year.

• Paid holidays.

• Leaves of absence.