Remote Senior Payer Contracting Strategist

Lumicera; Annapolis (MD); Remote; USD 120,000 - 170,000; Full time

Benefits offered by this job

Health insurance

Dental and Vision

401K match

Job summary

Lumicera Health Services is seeking a Payer Contracting Executive to lead end-to-end payer negotiations across commercial, Medicare Part D, and Medicaid for our specialty pharmacy. You will develop a payer access roadmap, identify non-participating networks, and secure agreements expanding access while protecting margin.

You will collaborate with trade relations, finance, legal, and compliance, coordinating credentialing, contract applications, and renewal strategies.

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 required.
• Support compliance program objectives and maintain professional standards.

Responsibilities

• Lead payer negotiations end to end, including rate and term negotiation and renewal strategy.
• Develop and execute a payer access roadmap for expanded payer contracts.
• Outreach to payers to identify credentialing and network requirements for new access.
• Negotiate pricing and service agreements with payers with policy and compliance oversight.
• Complete credentialing and new contract applications for payer and government clients.
• Track agreements through the contracting process with stakeholders.
• Meet with payer representatives to determine account management needs and ensure contract compliance.
• Recredential existing payer and government plans to prevent coverage gaps.
• Coordinate contracts and data needs for MSAs and scope of work documents.
• Develop relations with payers and resolve discrepancies with claims and payments.
• Review processes for regulatory compliance and required reporting.

Skills

Payer contracting

Managed care

Specialty pharmacy

Contract negotiation

Education

Bachelor's degree

MBA or graduate degree

Job description

Lumicera Health Services is seeking a Payer Contracting Executive to lead end-to-end payer negotiations across commercial, Medicare Part D, and Medicaid for our specialty pharmacy. You will develop a payer access roadmap, identify non-participating networks, and secure agreements expanding access while protecting margin.

You will collaborate with trade relations, finance, legal, and compliance, coordinating credentialing, contract applications, and renewal strategies.