Remote Payer Contracting Executive

Lumicera; Northern (KY); Hybrid; USD 116,000 - 145,000; Full time

Benefits offered by this job

Health benefits

PTO 20 days per year

Parental leave 4 weeks

401K match up to 5%

Adoption assistance

FSA

Job summary

Lumicera Health Services is seeking a Payer Contracting Executive to join our team. The role focuses on expanding payer access across commercial, Medicare Part D, and Medicaid opportunities, leading end-to-end negotiations, and developing a payer access roadmap to grow covered lives and protect margins.

The Executive will collaborate with trade relations, account management, finance, legal, and compliance, interfacing with external payer representatives to ensure contract success.

Qualifications

• Bachelor's degree required; 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.

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.

Skills

Payer contracting

Negotiation

Managed care

Specialty pharmacy

Education

Bachelor's degree

MBA or grad degree

Job description

Lumicera Health Services is seeking a Payer Contracting Executive to join our team. The role focuses on expanding payer access across commercial, Medicare Part D, and Medicaid opportunities, leading end-to-end negotiations, and developing a payer access roadmap to grow covered lives and protect margins.

The Executive will collaborate with trade relations, account management, finance, legal, and compliance, interfacing with external payer representatives to ensure contract success.