Remote Payer Contracting Executive

Lumicera; Austin (TX); Remote; USD 140,000 - 210,000; Full time

Benefits offered by this job

Health, dental, and vision insurance

20 days paid time off

4 weeks parental leave

9 paid holidays

401K company match up to 5%

Adoption Assistance Program

Flexible Spending Account

Educational Assistance Plan and Pro. M

Referral Bonus Program – up to $750!

Job summary

Lumicera Health Services is seeking a Payer Contracting Executive to lead end-to-end payer negotiations, expanding access across commercial, Medicare Part D, and Medicaid for our specialty pharmacy services.

The role partners with finance, legal, and compliance to develop payer access roadmaps, credentialing, and renewal strategies while safeguarding margins and patient access. Remote-friendly with cross-functional collaboration.

Qualifications

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

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 with non-network opportunities.
• Outreach to payers to identify credentialing and network requirements and pursue new access opportunities.
• Establish, monitor, and negotiate pricing and service agreements with payers with policy-compliant processes.
• Complete credentialing and new contract applications for payer and government clients with supporting documents.
• Track agreements through contracting process with internal and external stakeholders.
• Meet with payer representatives to determine account management needs and ensure contract compliance.
• Reenroll and recredential existing payer and government plans to avoid coverage gaps.
• Coordinate contracts and data needs for MSAs, shared service agreements, and scope of work documents.
• Develop relations with payers and resolve discrepancies with claims and payments.
• Review processes for regulatory and payer contract compliance.
• Ensure all specialty pharmacy reporting requirements are met for network contracts.
• Analyze data and prepare presentations for payer clients and leadership.
• Provide periodic reporting of activities and opportunities to leadership.

Skills

Negotiation

Stakeholder management

Strategic thinking

Team collaboration

Project coordination

Education

Bachelor's degree

MBA or graduate degree

Certified Pharmacy Technician

Job description

Lumicera Health Services is seeking a Payer Contracting Executive to lead end-to-end payer negotiations, expanding access across commercial, Medicare Part D, and Medicaid for our specialty pharmacy services.

The role partners with finance, legal, and compliance to develop payer access roadmaps, credentialing, and renewal strategies while safeguarding margins and patient access. Remote-friendly with cross-functional collaboration.