Remote Payer Contracting Executive: Expand Access & Margin

Lumicera; Little Rock (AR); À distance; USD 120 000 - 180 000; Plein temps

Avantages offerts par ce poste

Health insurance

Paid time off

Parental leave

401K match

Adoption Assistance Program

Flexible Spending Account

Educational Assistance

Referral Bonus Program – up to $750

Résumé du poste

Lumicera Health Services is seeking a Payer Contracting Executive to lead end-to-end payer negotiations across commercial, Medicare Part D, and Medicaid, with a focus on expanding access and protecting margin for our specialty pharmacy. You will develop a payer access roadmap, pursue new networks, and coordinate with legal, compliance, finance, and account management to secure favorable terms.

The role requires a Bachelor's degree and 5 years in payer contracting, with MBA preferred and

Qualifications

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

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

Managed care

Specialty pharmacy

Network negotiations

Compliance awareness

Formation

Bachelor's degree

MBA or graduate degree

Certified Pharmacy Technician

Description du poste

Lumicera Health Services is seeking a Payer Contracting Executive to lead end-to-end payer negotiations across commercial, Medicare Part D, and Medicaid, with a focus on expanding access and protecting margin for our specialty pharmacy. You will develop a payer access roadmap, pursue new networks, and coordinate with legal, compliance, finance, and account management to secure favorable terms.

The role requires a Bachelor's degree and 5 years in payer contracting, with MBA preferred and