Remote Payer Contracting Exec: Access & Networks

Lumicera; Salem (OR); Remote; USD 120,000 - 180,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

Paid time off

Parental leave

Job summary

Lumicera Health Services is seeking a Payer Contracting Executive to lead end-to-end negotiations across commercial markets, Medicare Part D, and Medicaid. This role focuses on expanding payer access, securing favorable network participation, and protecting margins for the specialty pharmacy.

The candidate will manage credentialing, contract applications, and pricing with payers, collaborating with cross-functional teams to optimize access and ensure regulatory compliance.

Qualifications

• Bachelor's degree required; MBA or graduate degree preferred.
• 5 years of payer contracting, managed care, or specialty pharmacy experience.
• Experience negotiating payer or network agreements in specialty pharmacy or managed care contracting.
• Working knowledge of commercial, Medicare Part D, and Medicaid payer environments and network access requirements.

Responsibilities

• Lead end-to-end payer negotiations, 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.

Skills

Payer contracting

Managed care

Specialty pharmacy

Negotiation

Network access

Regulatory compliance

Education

Bachelor's degree

MBA or graduate degree

Tools

Contract management software

Data analytics tools

Job description

Lumicera Health Services is seeking a Payer Contracting Executive to lead end-to-end negotiations across commercial markets, Medicare Part D, and Medicaid. This role focuses on expanding payer access, securing favorable network participation, and protecting margins for the specialty pharmacy.

The candidate will manage credentialing, contract applications, and pricing with payers, collaborating with cross-functional teams to optimize access and ensure regulatory compliance.