Payor Pricing Analyst (BioPlus)

Anticipated End Date:

Position Title:

Job Description:

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.

Please note that per our policy on hybrid/virtual work 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.

BioPlus Specialty Pharmacy is a proud member of the Elevance Health family of companies. BioPlus offer consumers and providers an unparalleled level of service thats easy and focused on whole health. Through our 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 consumers 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. This role is responsible for financial modeling contract analytics and reimbursement analysis across commercial Medicare and Medicaid payors.

How you will make an impact:

• 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.
  

Minimum Requirements:

• Requires a 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.
• Requires experience performing financial modeling and advanced spreadsheet analysis.

Preferred Skills Capabilities and Experiences:

• MBA or relevant advanced certification preferred.
• 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).

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Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes including those submitted to hiring managers are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy power our business outcomes and drive our shared success - for our consumers our associates our communities and our business.

We offer a range of market-competitive total rewards that include 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 to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager 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.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal state and local laws.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age citizenship status color creed disability ethnicity genetic information gender (including gender identity and gender expression) marital status national origin race religion sex sexual orientation veteran status or any other status or condition protected by applicable federal state or local laws. Applicants who require accommodation to participate in the job application process should submit the following form: Accessibility Accommodation Request Form and a member of the team will be in contact. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal state and local laws including but not limited to the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 Florida Agency for Health Care Administration.

NOTE: Workday keeps job postings active through 11:59:59 PM on the day before the listed end date. Example: If the end date is 3/13 the posting will automatically come down on 3/12 at 11:59:59 other words the job is posted until 3/13 not through 3/13.