Payer Contracting Executive

This is a fully remote position, open to applicants in Alabama, +26 more states.

📋 Description

• Oversee payer negotiations from start to finish, which includes negotiating rates and terms, network participation, performance guarantee structures, and strategies for renewal.

• Create and implement a roadmap for payer access aimed at expanding payer contracts.

• Investigate existing networks where Lumicera and its partner pharmacies are currently not included.

• Proactively reach out to payers to ascertain credentialing and network requirements, while pursuing new access opportunities.

• Establish, monitor, and negotiate pricing and service agreements with payers.

• Complete credentialing and new contract applications for both payer and government clients.

• Compile necessary documents and reports for payer applications, contracts, and business reviews.

• Track agreements throughout the contracting process with input from internal and external stakeholders.

• Meet with payer representatives to assess account management needs and ensure adherence to contract compliance.

• Reenroll and recredential existing payer and government plans, proactively monitoring for any coverage gaps.

• Coordinate projects that involve contracts and data requirements for master service agreements, shared service agreements, and scope of work documents.

• Cultivate relationships with established payers and address discrepancies related to claims and payments.

• Review operational and documentation processes to ensure compliance with regulatory and payer-contract standards.

• Ensure that specialty pharmacy reporting requirements are fulfilled to sustain network contracts.

• Analyze, compile, and prepare data analytics and presentations for payer clients and leadership.

• Provide periodic and comprehensive reports on activities and opportunities to leadership.

• Ensure adherence to applicable state and federal regulations.

• Perform additional duties as assigned.

⛳️ Requirements

• A bachelor's degree is required.

• A Master of Business Administration (MBA) or another graduate degree is preferred.

• Certification as a Pharmacy Technician or relevant industry certification is preferred.

• A minimum of 5 years of experience in payer contracting, managed care, or specialty pharmacy is required.

• Experience in negotiating payer or network agreements, ideally in the specialty pharmacy or managed care contracting sector, is required.

• A working knowledge of commercial, Medicare Part D, and Medicaid payer environments and their network access requirements is required.

• Must participate in, adhere to, and support compliance program objectives.

• Ability to consistently interact cooperatively and respectfully with colleagues is essential.

🏝️ Benefits

• Comprehensive benefits package for Health, Dental, and Vision insurance.

• 20 days of paid time off.

• 4 weeks of paid parental leave.

• 9 paid holidays.

• 401K company match of up to 5% with no vesting requirement.

• Adoption Assistance Program.

• Flexible Spending Account.

• Educational Assistance Plan and support for Professional Memberships.

• Referral Bonus Program offering up to $750!