Payer Contracting Manager, Home Infusion

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The Cigna Group

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1982

⚕️ Healthcare Insurance

💊 Pharmaceuticals

Healthcare Insurance • Pharmaceuticals

The Cigna Group is a global health company committed to improving the health and vitality of its clients, customers, and patients. With its two divisions, Cigna Healthcare and Evernorth Health Services, the company focuses on enhancing quality of life through healthcare services and pharmacy benefits management. The Cigna Group is dedicated to ethical practices in healthcare and artificial intelligence, and strives to create positive change in the healthcare system. It also emphasizes its Environmental, Social, and Governance (ESG) responsibilities, aiming to impact health equity and foster innovation in healthcare delivery.

📋 Description

• Partner with CarePathRx’s health system partners on optimizing contracts for their home infusion pharmacy including: Developing payor priorities for securing contracts • Reviewing payor contracts and related amendments and providing related recommendations • Evaluating and analyzing proposed rates against benchmarks, including per diem and drug rates • Partner guidance during health system implementation of their home infusion pharmacy for the health system partner and CarePathRx including: Aligning all processes to the overall implementation timelines, including payor credentialing application process • Providing consultation, education and training on contract requirements to Intake and Billing/Collection teams, including information regarding payor reimbursement methodologies, rates and policies • Working cross-functionally to ensure contract or amended rates and payor information is loaded accurately by the appropriate team for system optimization • Ensure ongoing success of the home infusion pharmacy contract strategy through: Maintaining the knowledgebase particular to benchmark rates and managed care terms; leverage this data to inform health system partner strategies • Managing payor contracts and amending reference materials to support all teams • Liaison with internal and external teams when needed for resolution of payer processing issues around payer contract load issues • Set the strategic direction for payer contract management, ensuring contracts are operationalized effectively to support accurate benefit verification, billing, and collections • Oversee payer change management strategy, including prioritization, risk mitigation, and cross‑functional coordination for payer updates across the client base. • Provide executive oversight for payer audits, ensuring timely, compliant, and effective responses while identifying systemic improvement opportunities. • Define cadences for review of contracting pricing and support on best practices to move forward optimizing outcomes and results • Serve as a trusted advisor to client executives and internal leadership, translating payer performance into strategic insights and recommendations • Foster strong cross‑functional relationships to align operations and partner managed care teams 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 • Strategic, analytical mindset with the ability to balance long‑term vision and operational outcomes • Expertise in building strong relationships with regional and national payors and health system clients in the managed care and leadership arena • Operational knowledge to translate contractual language into successful implementation with teams • 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, HCN EMR systems preferred.

🏖️ Benefits

• Health 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