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 our99.9% dispensing accuracy and commitment to patient care.

Role Overview

AmeriPharma is seeking a highly analytical Payor Contracts Specialistto manage the lifecycle of our national commercial contracting portfolio. This role is critical to our expansion across 47 states focusing on the technicalbuilding loading and maintenance of contractswithin our revenue cycle systems. You will be the architect of ourCharge 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 includingAWP-minus ASP-plus Per Diems and Flat Rateschedules 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 withinSpecialty Pharmacy Home Infusion or Hospital systems.
• Technical Expertise:Proven experience incontract 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 ofASP AWP WAC and CMS fee schedules as well as the nuances ofMedical vs. Pharmacy benefitreimbursement.
• 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).

AmeriPharmas 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.

Required Experience:

Senior IC