Remote Payer Contracting Executive

Lumicera; Olympia (WA); Remote; USD 120,000 - 165,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

Paid time off - 20 days

4 weeks paid 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 negotiations with commercial, Medicare Part D, and Medicaid payers, expanding access for our specialty pharmacy network. You will own end-to-end pricing, network participation, and renewal strategy while protecting margins and growing covered lives.

You’ll collaborate across finance, legal, and compliance to build payer access roadmaps, credentialing, and contract execution, reporting progress to leadership.

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.
• 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.

Skills

Payer contracting

Negotiation

Managed care

Education

Bachelor's degree

MBA

Certified Pharmacy Technician

Job description

Lumicera Health Services is seeking a Payer Contracting Executive to lead negotiations with commercial, Medicare Part D, and Medicaid payers, expanding access for our specialty pharmacy network. You will own end-to-end pricing, network participation, and renewal strategy while protecting margins and growing covered lives.

You’ll collaborate across finance, legal, and compliance to build payer access roadmaps, credentialing, and contract execution, reporting progress to leadership.