Payer Contracting Manager, Home Infusion

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

📋 Description

• Offer guidance to stakeholders regarding payer contract details.

• Create and manage a knowledge repository of home infusion contract reimbursement data.

• Provide advice to CarePathRx health system partners leveraging expertise in payer contracting.

• Act as a liaison and strategic partner to client leadership and internal stakeholders.

• Establish payer priorities to secure contracts effectively.

• Analyze payer contracts and amendments while offering recommendations.

• Assess proposed per diem and drug rates in comparison to benchmarks.

• Support health system implementation of home infusion pharmacies.

• Align processes with implementation timelines, including the submission of payer credentialing applications.

• Deliver consultation, education, and training related to contract requirements, reimbursement methods, rates, and policies.

• Coordinate cross-functionally to ensure accurate loading of contract, amended-rate, and payer information.

• Maintain knowledge bases for benchmark rates and managed-care terms.

• Manage payer contracts and update reference materials accordingly.

• Address payer processing and contract-load challenges with both internal and external teams.

• Set strategic direction for payer contract management and operationalization of contracts.

• Oversee payer change management, prioritization, risk mitigation, and coordination across functions.

• Provide executive oversight for payer audits and identify opportunities for systemic improvements.

• Define review frequencies and establish best practices for optimizing contracting pricing.

• Advise client executives and internal leadership with insights on strategic payer performance.

• Cultivate cross-functional relationships to enhance payer engagement strategies.

⛳️ Requirements

• High School Diploma or GED is mandatory.

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

• A minimum of 8 years of experience in payer or contract management within 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.

• Familiarity with HIPAA guidelines and federal, state, and local regulations pertaining to pharmacy or healthcare providers.

• Operational expertise to translate contractual language into successful implementation with teams.

• Proficient in establishing relationships with regional and national payors and health system clients in managed care and leadership settings.

• Capability to manage multiple priorities efficiently.

• Ability to work independently and meet deadlines effectively.

• Proficient in Microsoft Excel, Microsoft Word, and PowerPoint.

• Experience with CPR+, CareTend, and HCN EMR systems is preferred.

• Possess a strategic, analytical mindset with the ability to balance long-term vision and operational results.

• For remote work, internet connection must be through a cable broadband or fiber optic provider with speeds of at least 10Mbps download and 5Mbps upload.

🏝️ Benefits

• Eligibility for an annual bonus plan.

• Medical insurance coverage.

• Vision insurance coverage.

• Dental insurance coverage.

• Access to well-being and behavioral health programs.

• 401(k) retirement plan.

• Company-paid life insurance.

• Tuition reimbursement program.

• Minimum of 18 days of paid time off annually.

• Paid holidays.

• Leaves of absence available.

• Remote work arrangement offered.

• Requirement for cable broadband or fiber optic internet service with minimum speeds of 10Mbps download and 5Mbps upload for home-based work.