Remote Payer Contracting Executive: Expand Access & Margin

Lumicera; Montgomery (AL); Remote; USD 130,000 - 165,000; Full time

Benefits offered by this job

Health and dental insurance (top of 
-

Paid time off - 20 days

Parental leave - 4 weeks

Paid holidays - 9

401K company match up to 5%

Adoption assistance

Flexible Spending Account

Educational assistance & professional

Referral bonus up to $750

Job summary

Lumicera is seeking a Payer Contracting Executive to lead end-to-end payer negotiations across commercial, Medicare Part D, and Medicaid, expanding network access for Lumicera and partner pharmacies. You will independently outreach to payers, credentialing, and manage pricing and contracts while ensuring regulatory compliance.

You will collaborate with trade relations, finance, legal, and compliance, driving business reviews and strategic opportunities to maximize access and protect margins in

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

Managed care

Negotiation

Healthcare industry knowledge

Education

Bachelor's degree

MBA preferred

Certified Pharmacy Technician

Job description

Lumicera is seeking a Payer Contracting Executive to lead end-to-end payer negotiations across commercial, Medicare Part D, and Medicaid, expanding network access for Lumicera and partner pharmacies. You will independently outreach to payers, credentialing, and manage pricing and contracts while ensuring regulatory compliance.

You will collaborate with trade relations, finance, legal, and compliance, driving business reviews and strategic opportunities to maximize access and protect margins in