Remote Payer Contracting Executive: Expand Access

Navitus Health Solutions; United States; Remote; USD 116,000 - 145,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

Paid time off

Parental leave

9 paid holidays

401K match

Adoption Assistance

Flexible Spending Account

Educational Assistance

Referral Bonus

Job summary

Lumicera Health Services is seeking a Payer Contracting Executive to expand payer access across commercial, Medicare Part D, and Medicaid opportunities. The role leads end-to-end negotiations, credentialing, and network expansion, partnering with cross-functional teams to protect margins for specialty pharmacy.

The ideal candidate will manage pricing, contracts, and reporting, ensure regulatory compliance, and drive payer strategy across government and commercial programs.

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.
• Working knowledge of commercial, Medicare Part D, and Medicaid payer environments and network access requirements required.
• Participate in, adhere to, and support compliance program objectives.
• The ability to consistently interact cooperatively and respectfully with other employees.

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 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.

Skills

Payer contracting

Negotiation

Compliance

Teamwork

Education

Bachelor's degree

MBA

Job description

Lumicera Health Services is seeking a Payer Contracting Executive to expand payer access across commercial, Medicare Part D, and Medicaid opportunities. The role leads end-to-end negotiations, credentialing, and network expansion, partnering with cross-functional teams to protect margins for specialty pharmacy.

The ideal candidate will manage pricing, contracts, and reporting, ensure regulatory compliance, and drive payer strategy across government and commercial programs.