Job Details

About AmeriPharma

AmeriPharma is a rapidly growing healthcare company where you will have the opportunity to contribute to our joint success on a daily basis. We value new ideas, creativity, and productivity. We like people who are passionate about their roles and people who like to growand change as the company evolves.

AmeriPharma's Benefits

• Full benefits package including medical, dental, vision, and life
• Great pay and general compensation structures
• Employee assistance program to assist with mental health, legal questions, financial counseling etc.
• Comprehensive PTO and sick leave options
• 401k program
• Plenty of opportunities for growth and advancement
• Company sponsored outings and team-building events
• Casual Fridays

JOB SUMMARY

The Provider Contracting Specialist isresponsible for managing assigned payer relationships and supporting the successful drafting, negotiation, execution, implementation, and ongoing administration of payer contracts. This role serves as a primary liaison between the organization and its payers, focusing on establishing long-term, productive partnerships, maintaining contract compliance, and identifying opportunities to improve financial performance, operational efficiency, and contract terms. The Specialist is expected to work independently, coordinate cross-functional stakeholders, and provide subject matter support within the specialty pharmacy, infusion therapy, and broader healthcare contracting environment.

DUTIES AND RESPONSIBILITIES

• Develop and maintain network relationships with payers, advocate for mutual interests, and support issue resolution in alignment with company policies and organizational objectives.
• Engage strategically with payers to support network participation, reimbursement stability, and Organization's business goals.
• Draft, review, coordinate negotiation of, and support execution and implementation of payer contracts to promote favorable and equitable terms for Organization.
• Monitor financial performance across assigned payer contracts, identify trends, variances, denials, and non-compliance issues, and escalate recommendations as appropriate.
• Maintain fairness and consistency across payer agreements in alignment with organizational standards and approved contracting parameters.
• Maintain organizational documents used to educate appropriate subsidiaries on managed care contracts, including contract databases, matrices, and related reference materials.
• Facilitate resolution of escalated contractual, payer policy, operational, and claims-related issues through collaboration with managed care organizations and internal stakeholders.
• Collaborate with practices and internal stakeholders to develop effective payer contracting strategies that optimize network access and reimbursement.
• Guide practices and internal stakeholders through contract negotiations by providing support, analysis, and subject matter expertise.
• Coordinate with pharmacy, revenue cycle, operations, clinical, compliance, and leadership teams to assess the impacts of payer contracts on different divisions and service lines.
• Manage contract-related challenges and opportunities within assigned areas and help track implementation needs, risks, and action items.
• Serve as a subject matter resource on pharmacy and medical contracting, including managed care, specialty, long-term care, home infusion networks, PSAOs, PBMs, and related payer relationships.
• Ensure contracts meet applicable regulatory requirements and incorporate effective strategies for payer-specific policies and operational requirements.
• Contribute to the strategic direction of payer contracting by developing analyses, recommendations, and contract optimization opportunities for leadership review.
• Stay informed on industry trends, regulatory changes, market developments, and payer-specific policies that may affect contract performance, and communicate relevant updates to internal stakeholders.
• Present complex contract terms, payer policy implications, and performance data in a professional and understandable manner to internal stakeholders.
• Track contract performance and compliance through reporting, follow-up, and regular evaluation of contract obligations and outcomes.
• Demonstrate knowledge of payment methodologies for commercial and government payers and support alignment of related departmental processes.
• Coordinate payer contracting projects and related efforts for new contract opportunities, renewals, risks, and challenges, ensuring timely follow-through and organizational alignment.
• Maintain working knowledge of government healthcare plans and support effective contracts within those frameworks.
• Understand commercial insurance models and incorporate those insights into contract evaluation, negotiation support, and payer relationship management.
• Represent Organization professionally and credibly in all payer interactions.

REQUIRED QUALIFICATIONS

• Deep understanding of government programs, including Medicare, Medicaid, and TriCare, as well as commercial insurance models relevant to payer contract terms.
• Ability to manage large volumes of complex contracts, projects, and follow-up items while adhering to deadlines.
• Familiarity with claims adjudication, denials, underpayments, and related non-compliance issue resolution.
• Proficiency in word processing, spreadsheets, databases, and scheduling applications.
• Exceptional verbal and written communication skills, including the ability to present complex topics clearly.
• Experience synthesizing extensive data into concise summaries, recommendations, and action plans.
• Willingness to travel for negotiations, meetings, and relationship-building activities as needed.

EDUCATION AND EXPERIENCE REQUIREMENTS

• Bachelor's degree from an accredited institution or equivalent combination of education and relevant experience.
• 1+ years of experience in pharmacy contracting, pharmacy quality improvement, and/or pharmacy regulatory and payer compliance.
• 3+ years of professional experience in contract management or payer relations within the healthcare space; specialty pharmacy and/or infusion therapy experience preferred.
• 3+ years of experience drafting, negotiating, and managing healthcare payer contracts.
• Proven experience working with health plans, PBMs, PSAOs, and other payer organizations.

REQUIRED SKILLS

• Strong experience developing internal and external relationships and cross-functional partnerships.
• Knowledge of pharmacy systems, pharmacy workflows, claims adjudication, claim rejections, and associated resolution processes.
• Ability to manage customer and payer expectations regarding service levels, contract interpretation, and issue resolution.
• Strong Microsoft Office and communication platform skills.
• Ability to interpret, adapt, and apply guidelines, procedures, and contract language accurately.
• Strong analytical, problem-solving, and decision-making skills, with close attention to detail.
• Continuous quality improvement mindset, including review of work product for accuracy, completeness, and consistency.
• Ability to work independently, prioritize effectively, manage time efficiently, and handle multiple concurrent priorities.
• Excellent interpersonal, organizational, and customer service skills, with the ability to function well in a fast-paced and at times stressful environment.
• Ability to maintain confidentiality and exercise sound professional judgment.

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 physical demands 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. While performing the duties of this job, the employee is continuously required to sit and talk or hear. The employee is occasionally required to stand; walk; use hands to finger, handle, or feel objects, tools, or controls; reach with hands and arms; and stoop, kneel, crouch or crawl. The employee must regularly lift and/or move up to 20 pounds and occasionally lift/or move up to 30 pounds. Specific vision abilities required by this job include close vision, peripheral vision, depth perception and the ability to adjust focus.

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 based on disability or any other legally protected class.