Payer Contracting Executive

This job was posted by https://www.arjoblink.arkansas.gov : For more information, please see: https://www.arjoblink.arkansas.gov/jobs/4881501\ \ Overview\ Lumicera Health Services is seeking a Payer Contracting Executiveto join our team! The Payer Contracting Executive serves as a dedicated negotiator focused on expanding payer access across commercial, Medicare Part D, and Medicaid opportunities. The primary responsibility of this position is to lead payer negotiations end to end, including rate and term negotiation, network participation, performance guarantee structures, and renewal strategy, to grow covered lives and protect margin for the specialty pharmacy. The Payer Contracting Executive will develop and execute a payer access roadmap, identify and pursue networks in which Lumicera and its partner pharmacies are not currently participating, and secure agreements that maximize access to patients and members. The Payer Contracting Executive will support Lumicera and all strategic partners for whom Lumicera provides shared services to help meet strategic goals and mitigate financial losses. This position partners closely with trade relations, account management, finance, legal, and compliance, and interfaces with external payer representatives with respect to specialty pharmacy services and contracting duties. Is this you? Find out more below! \ \ Responsibilities\ How do I make an impact on my team? - 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. \ \ Qualifications\ **What \ \ \ Equal employment opportunity, including veterans and individuals with disabilities.\ \ ** PI287922027