Payor Contracts Specialist (RCM)

AmeriPharma • Laguna Hills, CA

9d • $28 - $38 • Onsite

About The Position

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.

Requirements

• 4+ years in Payor Contracting, Managed Care, or Revenue Cycle Management, specifically within Specialty Pharmacy, Home Infusion, or Hospital systems.
• Proven experience in contract loading and Charge Master maintenance. Must understand the technical workflow of how a contract term becomes a billable line item.
• Deep knowledge of ASP, AWP, WAC, and CMS fee schedules, as well as the nuances of Medical vs. Pharmacy benefit reimbursement.
• Advanced Excel skills (data modeling) and proficiency with billing platforms (e.g., CPR+, Brightree, or Waystar).

Nice To Haves

• Experience managing national or multi-state provider contracts is highly preferred.

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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed