Payer Contracting Executive

Lumicera; Tallahassee (FL); Remote; USD 120,000 - 180,000; Full time

Benefits offered by this job

Health, Dental, Vision insurance

20 days paid time off

4 weeks paid parental leave

9 paid holidays

401K match up to 5%

Adoption Assistance Program

Flexible Spending Account

Educational Assistance and Membership

Referral Bonus Program – up to $750

Remote-friendly

Job summary

Lumicera Health Services seeks a Payer Contracting Executive to expand payer access across commercial, Medicare Part D, and Medicaid for specialty pharmacy. You will lead negotiations, credentialing, and contract strategy while partnering with finance, legal, and compliance to drive margin and growth.

The role involves developing payer roadmaps, outreach to payers, and managing contract workflows, with a focus on network participation and ongoing performance management.

Qualifications

• Bachelor's degree required.
• MBA or related graduate degree preferred.
• 5 years or more in payer contracting or related field.
• Experience with commercial, Medicare Part D, and Medicaid payer environments.
• Experience negotiating payer or network agreements.
• Knowledge of network access requirements and credentialing processes.

Responsibilities

• Lead end-to-end payer negotiations, including rate and term negotiation and renewal strategy.
• Develop a payer access roadmap to expand contract participation.
• Outreach to payers to identify credentialing and network requirements.
• Negotiate pricing and service agreements with payers per policy and compliance.
• Prepare documents for payer applications, contracts, and reviews.
• Track contract progress and coordinate with internal/external stakeholders.
• Meet with payer reps to determine account management needs and ensure contract compliance.
• Recredential existing payer plans and monitor for gaps in coverage.
• Coordinate data needs for master service agreements and scope of work documents.
• Develop relationships with payers and resolve discrepancies in claims/payments.
• Review processes for regulatory compliance and contract alignment.
• Ensure specialty pharmacy reporting requirements are met.
• Provide data analytics and reporting to leadership.

Skills

Payer contracting

Managed care

Specialty pharmacy

Negotiation

Regulatory compliance

Stakeholder management

Education

Bachelor's degree

MBA or graduate degree preferred

Job description

Overview

Lumicera Health Services is seeking a Payer Contracting Executive to join our team!

The Payer Contracting Executive serves as a dedicated negotiator focused on expanding payer access across commercial, Medicare Part D, and Medicaid opportunities. The primary responsibility of this position is to lead payer negotiations end to end, including rate and term negotiation, network participation, performance guarantee structures, and renewal strategy, to grow covered lives and protect margin for the specialty pharmacy. The Payer Contracting Executive will develop and execute a payer access roadmap, identify and pursue networks in which Lumicera and its partner pharmacies are not currently participating, and secure agreements that maximize access to patients and members.

The Payer Contracting Executive will support Lumicera and all strategic partners for whom Lumicera provides shared services to help meet strategic goals and mitigate financial losses. This position partners closely with trade relations, account management, finance, legal, and compliance, and interfaces with external payer representatives with respect to specialty pharmacy services and contracting duties.

Is this you? Find out more below!

Responsibilities

• Lead payer negotiations end to end, including rate and term negotiation, network participation, performance guarantee structures, and renewal strategy.
• Develop and execute a payer access roadmap for expanded payer contracts, investigating current networks where Lumicera and its partner pharmacies are not in network.
• Independently outreach to payers to identify credentialing and network requirements and to pursue new access opportunities.
• Establish, monitor, and negotiate pricing and service agreements with payers, following company policy regarding contract management, including legal and compliance review and oversight.
• Complete credentialing and new contract applications for payer and government clients, and compile supporting documents and reports for payer applications, contracts, and business reviews.
• Track agreements through the contracting process from reception to completion with both internal and external stakeholder input.
• Meet with payer representatives to determine account management needs of the payer and to ensure contract compliance.
• Reenroll and recredential existing payer and government plans, monitoring proactively to ensure no gaps in coverage.
• Coordinate projects involving contracts and data needs for master service agreements, shared service agreements, and scope of work documents, including data and enhanced service opportunities.
• Develop relations and contacts with established payers and resolve discrepancies with claims and payments.
• Review operational and documentation processes to ensure compliance with regulatory requirements and payer contracts.
• Ensure all specialty pharmacy reporting requirements are met to maintain network contracts.
• Analyze, compile, and prepare data analytics and presentations for payer clients and leadership.
• Provide periodic and detailed reporting of activities and opportunities to leadership.
• Ensure compliance with all applicable state and federal regulations.
• Other duties as assigned.

Qualifications

• Bachelor's degree required. Master of Business Administration (MBA) or other graduate degree preferred.
• Certified Pharmacy Technician or relevant industry certification preferred.
• 5 years of payer contracting, managed care, or specialty pharmacy experience required.
• Experience negotiating payer or network agreements, preferably in specialty pharmacy or managed care contracting, required.
• Working knowledge of commercial, Medicare Part D, and Medicaid payer environments and network access requirements required.
• Participate in, adhere to, and s support compliance program objectives.
• The ability to consistently interact cooperatively and respectfully with other employees.

What can you expect from Lumicera?

• Top of the industry benefits for Health, Dental, and Vision insurance

• 20 days paid time off

• 4 weeks paid parental leave

• 9 paid holidays

• 401K company match of up to 5% - No vesting requirement

• Adoption Assistance Program

• Flexible Spending Account

• Educational Assistance Plan and Professional Membership assistance

• Referral Bonus Program – up to $750!

#LI-Remote

Navitus Health Solutions is an Equal Opportunity Employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, creed, sex, pregnancy, sexual orientation, gender identity or expression, national origin, age, disability, genetic information, veteran status, or any other characteristic protected by law.

Equal employment opportunity, including veterans and individuals with disabilities.