Payor Contracts Specialist (RCM)

Why AmeriPharma?

As we scale our Infusion Suites and specialty services nationally, you will play a foundational role in our financial health. Your expertise ensures that our clinical excellence is matched by administrative precision, allowing us to maintain our 99.9% dispensing accuracy and commitment to patient care.

Role Overview

AmeriPharma is seeking a highly analytical Payor Contracts Specialist to manage the lifecycle of our national commercial contracting portfolio. This role is critical to our expansion across 47 states, focusing on the technical building, loading, and maintenance of contracts within our revenue cycle systems. You will be the architect of our Charge Master, ensuring that diverse fee schedules and reimbursement methodologies are accurately captured to drive clean claims and optimal revenue integrity.

Key Responsibilities

• Contract Loading & Configuration: Accurately build and load commercial payor contracts into the pharmacy management and billing systems, ensuring 100% alignment with executed terms.
• Charge Master Management: Maintain and update the Corporate Charge Master, aligning HCPCS, J-Codes, and NDC-based pricing across various service lines (Specialty Pharmacy, HIT, and DME).
• Fee Schedule Analysis: Manage complex reimbursement methodologies, including AWP-minus, ASP-plus, Per Diems, and Flat Rate schedules across multiple geographic regions.
• National Compliance: Monitor and adjust contracts to account for state-specific regulations and varied payor requirements across our 47-state footprint.
• Financial Modeling: Support the Director by modeling the impact of proposed rate changes and identifying "carve-out" opportunities for high-cost therapies like IVIG and Oncology.
• Revenue Cycle Support: Partner with the Billing and Revenue Integrity teams to resolve systematic underpayments resulting from contract loading errors or fee schedule discrepancies. 

Qualifications & Experience

• Experience: 4+ years in Payor Contracting, Managed Care, or Revenue Cycle Management, specifically within Specialty Pharmacy, Home Infusion, or Hospital systems.
• Technical Expertise: Proven experience in contract loading and Charge Master maintenance. Must understand the technical workflow of how a contract term becomes a billable line item.
• Fee Schedule Mastery: Deep knowledge of ASP, AWP, WAC, and CMS fee schedules, as well as the nuances of Medical vs. Pharmacy benefit reimbursement.
• Geography: Experience managing national or multi-state provider contracts is highly preferred.
• Software Skills: Advanced Excel skills (data modeling) and proficiency with billing platforms (e.g., CPR+, Brightree, or Waystar). 

AmeriPharma’s Mission Statement 

Our goal is to achieve superior clinical and economic outcomes while maintaining the utmost compassion and care for our patients. It is our joint and individual responsibility daily to demonstrate to outpatients, prescribers, colleagues, and others that We Care!

Physical Requirements 

The following physical activities described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions and expectations

EEO Statement 

The above statements are intended to describe the work being performed by people assigned to this job. They are not intended to be an exhaustive list of all responsibilities, duties and skills required. The duties and responsibilities of this position are subject to change and other duties may be assigned or removed at any time. AmeriPharma values diversity in its workforce and is proud to be an AAP/EEO employer. All qualified applicants will receive consideration for employment without regard to race, sex, color, religion, sexual orientation, gender identity, national origin, age, protected veteran status, or on the basis of disability or any other legally protected class.