Remote Payer Contracts Leader

Lumicera; Trenton (NJ); On-site; USD 120,000 - 180,000; Full time

Benefits offered by this job

Health, dental, vision insurance

20 days PTO

4 weeks parental leave

9 holidays

401K match up to 5%

Adoption assistance

Flexible Spending Account

Educational & membership support

Referral bonus up to $750

Job summary

Lumicera Health Services seeks a Payer Contracting Executive to expand payer access across commercial, Medicare Part D, and Medicaid. This role leads end-to-end negotiations, builds network participation, and shapes renewal strategy to grow covered lives and protect margins for specialty pharmacy.

You will collaborate with finance, legal, and compliance while coordinating credentialing, contract applications, and reporting for payer engagements.

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.

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

Specialty pharmacy

Negotiation

Compliance

Regulatory knowledge

Education

Bachelor's degree

MBA

Certified Pharmacy Technician or related certification

Job description

Lumicera Health Services seeks a Payer Contracting Executive to expand payer access across commercial, Medicare Part D, and Medicaid. This role leads end-to-end negotiations, builds network participation, and shapes renewal strategy to grow covered lives and protect margins for specialty pharmacy.

You will collaborate with finance, legal, and compliance while coordinating credentialing, contract applications, and reporting for payer engagements.