Remote Payer Contracting Executive — Access & Margin

Lumicera; Tallahassee (FL); Remote; USD 120,000 - 180,000; Full time

Benefits offered by this job

Health, Dental, Vision insurance

20 days paid time off

4 weeks paid parental leave

9 paid holidays

401K match up to 5%

Adoption Assistance Program

Flexible Spending Account

Educational Assistance and Membership

Referral Bonus Program – up to $750

Remote-friendly

Job summary

Lumicera Health Services seeks a Payer Contracting Executive to expand payer access across commercial, Medicare Part D, and Medicaid for specialty pharmacy. You will lead negotiations, credentialing, and contract strategy while partnering with finance, legal, and compliance to drive margin and growth.

The role involves developing payer roadmaps, outreach to payers, and managing contract workflows, with a focus on network participation and ongoing performance management.

Qualifications

• Bachelor's degree required.
• MBA or related graduate degree preferred.
• 5 years or more in payer contracting or related field.
• Experience with commercial, Medicare Part D, and Medicaid payer environments.
• Experience negotiating payer or network agreements.
• Knowledge of network access requirements and credentialing processes.

Responsibilities

• Lead end-to-end payer negotiations, including rate and term negotiation and renewal strategy.
• Develop a payer access roadmap to expand contract participation.
• Outreach to payers to identify credentialing and network requirements.
• Negotiate pricing and service agreements with payers per policy and compliance.
• Prepare documents for payer applications, contracts, and reviews.
• Track contract progress and coordinate with internal/external stakeholders.
• Meet with payer reps to determine account management needs and ensure contract compliance.
• Recredential existing payer plans and monitor for gaps in coverage.
• Coordinate data needs for master service agreements and scope of work documents.
• Develop relationships with payers and resolve discrepancies in claims/payments.
• Review processes for regulatory compliance and contract alignment.
• Ensure specialty pharmacy reporting requirements are met.
• Provide data analytics and reporting to leadership.

Skills

Payer contracting

Managed care

Specialty pharmacy

Negotiation

Regulatory compliance

Stakeholder management

Education

Bachelor's degree

MBA or graduate degree preferred

Job description

Lumicera Health Services seeks a Payer Contracting Executive to expand payer access across commercial, Medicare Part D, and Medicaid for specialty pharmacy. You will lead negotiations, credentialing, and contract strategy while partnering with finance, legal, and compliance to drive margin and growth.

The role involves developing payer roadmaps, outreach to payers, and managing contract workflows, with a focus on network participation and ongoing performance management.