Payer Contracting Executive — Remote Access Growth

Lumicera; Raleigh (NC); Remote; USD 120,000 - 180,000; Full time

Benefits offered by this job

Health benefits

PTO 20 days

Parental leave

Holidays 9

401K match

Adoption assistance

FSA

Educational assistance

Referral bonus

Job summary

Lumicera Health Services is seeking a Payer Contracting Executive to join our team. This role leads negotiations with commercial, Medicare Part D, and Medicaid payers to grow covered lives and protect margins for our specialty pharmacy services.

Based remotely in the United States, you will develop and execute payer access roadmaps, credentialing, and contract management while coordinating with finance, legal, and compliance to ensure contract success and regulatory compliance.

Qualifications

• Bachelor's degree required; MBA or 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 support compliance program objectives.
• The ability to consistently interact cooperatively and respectfully with other employees.

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.

Education

Bachelor's degree

MBA

Job description

Lumicera Health Services is seeking a Payer Contracting Executive to join our team. This role leads negotiations with commercial, Medicare Part D, and Medicaid payers to grow covered lives and protect margins for our specialty pharmacy services.

Based remotely in the United States, you will develop and execute payer access roadmaps, credentialing, and contract management while coordinating with finance, legal, and compliance to ensure contract success and regulatory compliance.