Remote Payer Contracting Executive - Access & Margin Growth

Lumicera; Lincoln (NE); Remote; USD 120,000 - 150,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

20 days PTO

4 weeks parental leave

9 paid holidays

401K match up to 5%

Adoption Assistance Program

Flexible Spending Account

Educational Assistance Plan

Professional Membership assistance

Referral Bonus Program – up to $750

Job summary

Lumicera Health Services is seeking a Payer Contracting Executive to lead negotiations across commercial, Medicare Part D, and Medicaid, expanding payer access and protecting margins for our specialty pharmacy. You will develop a roadmap, credential and contract with payers, and coordinate with internal teams to ensure contract compliance and favorable terms.

The role collaborates with trade relations, account management, finance, legal, and compliance, interfacing with external payer

Qualifications

• Bachelor's degree required; MBA or graduate degree preferred.
• Certified Pharmacy Technician or relevant 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.
• Working knowledge of commercial, Medicare Part D, and Medicaid payer environments and network access requirements.
• Participation in compliance program objectives and ability to interact cooperatively with others.

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 networks not in network.
• Independently outreach to payers to identify credentialing and network requirements and pursue new access opportunities.
• Establish, monitor, and negotiate pricing and service agreements with payers, including legal and compliance review.
• Complete credentialing and new contract applications for payer and government clients, with supporting documents and reports.
• Track agreements through contracting process with input from internal and external stakeholders.
• Meet with payer representatives to determine account management needs and ensure contract compliance.
• Reenroll and recredential existing payer and government plans to prevent gaps in coverage.
• Coordinate contracts and data needs for master service agreements and scope of work documents.
• Develop relations with established payers and resolve discrepancies with claims and payments.
• Review processes to ensure regulatory and contract compliance; ensure all reporting requirements are met.

Skills

Payer contracting

Negotiation

Regulatory compliance

Interpersonal communication

Education

Bachelor's degree

MBA or graduate degree preferred

Certified Pharmacy Technician preferred

Job description

Lumicera Health Services is seeking a Payer Contracting Executive to lead negotiations across commercial, Medicare Part D, and Medicaid, expanding payer access and protecting margins for our specialty pharmacy. You will develop a roadmap, credential and contract with payers, and coordinate with internal teams to ensure contract compliance and favorable terms.

The role collaborates with trade relations, account management, finance, legal, and compliance, interfacing with external payer