Remote Payer Contracting Executive: Access & Growth Lead

Lumicera; Atlanta (GA); Sur place; USD 120 000 - 170 000; Plein temps

Avantages offerts par ce poste

Health insurance (Top of the industry)

Dental insurance (Top of the industry)

Vision insurance (Top of the industry)

20 days PTO

4 weeks parental leave

9 holidays

401K match up to 5%

Adoption Assistance

Flexible Spending Account

Educational assistance & professional-

Referral bonus up to $750

Résumé du poste

Lumicera Health Services is seeking a Payer Contracting Executive to join our team. This role leads negotiations with commercial, Medicare Part D, and Medicaid payers to grow access for Lumicera’s specialty pharmacy network and protect margins.

You will develop a payer access roadmap, pursue new networks, credentialing, and contract enforcement while collaborating with legal, finance, and compliance to ensure regulatory alignment and contract integrity across all programs.

Qualifications

• Bachelor's degree required; MBA or 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.
• Working knowledge of commercial, Medicare Part D, and Medicaid payer environments and network access requirements.

Responsabilités

• 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.

Connaissances

Payer contracting

Negotiation

Relationship building

Regulatory compliance

Data analysis

Formation

Bachelor's degree

MBA or graduate degree preferred

Description du poste

Lumicera Health Services is seeking a Payer Contracting Executive to join our team. This role leads negotiations with commercial, Medicare Part D, and Medicaid payers to grow access for Lumicera’s specialty pharmacy network and protect margins.

You will develop a payer access roadmap, pursue new networks, credentialing, and contract enforcement while collaborating with legal, finance, and compliance to ensure regulatory alignment and contract integrity across all programs.