Remote Payer Contracting Executive

Lumicera; Saint Paul (MN); Remote; USD 110,000 - 170,000; Full time

Benefits offered by this job

Health insurance

Paid time off 20 days

Parental leave 4 weeks

Paid holidays 9

401K match 5%

Adoption assistance

FSA

Educational assistance

Membership assistance

Referral bonus up to $750

Job summary

Lumicera Health Services is seeking a Payer Contracting Executive to lead end-to-end negotiations with commercial, Medicare Part D, and Medicaid payers, expanding network access and protecting margins for the specialty pharmacy.

The role involves developing payer access roadmaps, credentialing, and contract management while collaborating with finance, legal, and compliance to ensure regulatory adherence and contract integrity.

Qualifications

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

Responsibilities

• Lead payer negotiations end to end, including rate and term negotiation, network participation, performance guarantees, and renewal strategy.
• Develop and execute a payer access roadmap for expanded contracts and identify un-networked payers.
• Independently outreach to payers to identify credentialing and network requirements and pursue access opportunities.
• Establish, monitor, and negotiate pricing and service agreements with payers per policy; include legal/compliance review.
• Complete credentialing and new contract applications for payer/government clients; prepare supporting documents.
• Track agreements through contracting process with internal/external input.
• Meet with payer representatives to determine account management needs and ensure contract compliance.
• Reenroll and recredential existing payer/government plans; monitor to prevent coverage gaps.
• Coordinate contracts/data needs for master service agreements and scope of work documents.
• Develop relationships with established payers and resolve discrepancies with claims/payments.
• Review processes to ensure regulatory and contract compliance.
• Ensure all reporting requirements for specialty pharmacy are met; prepare data/ presentations for clients and leadership.

Skills

Payer contracting

Contract negotiations

Managed care

Specialty pharmacy

Compliance awareness

Education

Bachelor's degree

MBA preferred

Job description

Lumicera Health Services is seeking a Payer Contracting Executive to lead end-to-end negotiations with commercial, Medicare Part D, and Medicaid payers, expanding network access and protecting margins for the specialty pharmacy.

The role involves developing payer access roadmaps, credentialing, and contract management while collaborating with finance, legal, and compliance to ensure regulatory adherence and contract integrity.