Director of Billing

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    "description": "<p><span style=\"font-family: arial, helvetica, sans-serif; font-size: 12pt; font-weight: bold\">About AmeriPharma</span><br><span style=\"font-size: 12pt\"><span style=\"font-family: arial, helvetica, sans-serif\">AmeriPharma Specialty Care is a national specialty pharmacy and home infusion provider serving patients with </span><span style=\"font-family: arial, helvetica, sans-serif\">complex and rare conditions, including IVIG and SCIG therapy, TPN, biologics, oncology support, and rare disease </span><span style=\"font-family: arial, helvetica, sans-serif\">therapies. AmeriPharma operates accredited ambulatory infusion centers and provides home-based infusion </span><span style=\"font-family: arial, helvetica, sans-serif\">nationwide, supported by a fully integrated intake, clinical, and revenue cycle infrastructure. The MedBox </span><span style=\"font-family: arial, helvetica, sans-serif\">division extends AmeriPharma’s mission to senior, home-based, and long-term care populations through </span><span style=\"font-family: arial, helvetica, sans-serif\">medication adherence and multidose packaging services.</span></span></p>\n<p><br></p>\n<p><span style=\"font-family: arial, helvetica, sans-serif; font-size: 12pt; font-weight: bold\">Position Summary</span><br><span style=\"font-size: 12pt\"><span style=\"font-family: arial, helvetica, sans-serif\">AmeriPharma Specialty Care is seeking a Director of Billing to lead and elevate billing operations across both the </span><span style=\"font-family: arial, helvetica, sans-serif\">Medical Benefit (Part B and Major Medical) and Pharmacy Benefit (Part D and PBM) channels. This leader will </span><span style=\"font-family: arial, helvetica, sans-serif\">own end-to-end professional billing performance for specialty pharmacy, home infusion, infusion suite (AIC), </span><span style=\"font-family: arial, helvetica, sans-serif\">and complex therapy lines, ensuring every service, supply, and medication is captured, coded, and reimbursed </span><span style=\"font-family: arial, helvetica, sans-serif\">accurately, completely, and in full compliance with payer and regulatory requirements.</span></span></p>\n<p><br><span style=\"font-size: 12pt\"><span style=\"font-family: arial, helvetica, sans-serif\">The Director is accountable for first-pass clean claim performance, reimbursement integrity, denial prevention, </span><span style=\"font-family: arial, helvetica, sans-serif\">and the operational discipline required to convert clinical activity into realized revenue. The role partners closely </span><span style=\"font-family: arial, helvetica, sans-serif\">with Contracting, Intake, Pharmacy Operations, Clinical, and Compliance to ensure billing practices reflect </span><span style=\"font-family: arial, helvetica, sans-serif\">current contract terms, payer policy, and documentation standards.</span></span></p>\n<p><br></p>\n<p><span style=\"color: rgb(34, 34, 34); font-family: arial, helvetica, sans-serif; font-size: 12pt; font-weight: bold\">Why Join Us?</span></p>\n<p><span style=\"font-family: arial, helvetica, sans-serif; font-size: 12pt\">We're a rapidly growing digital pharmacy 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 grow and change as the company evolves.</span></p>\n<p><span style=\"font-family: arial, helvetica, sans-serif; font-size: 12pt\"> </span></p>\n<p><span style=\"font-family: arial, helvetica, sans-serif; font-size: 12pt\">At AmeriPharma, you'll have access to:</span></p>\n<p><br></p>\n<ul>\n<li><span style=\"font-family: arial, helvetica, sans-serif; font-size: 12pt\">Competitive pay and generous compensation structures</span></li>\n<li><span style=\"font-family: arial, helvetica, sans-serif; font-size: 12pt\">Full benefits package including medical, dental, vision, and life that fits your lifestyle and goals</span></li>\n<li><span style=\"font-family: arial, helvetica, sans-serif; font-size: 12pt\">Employee assistance program to assist with mental health, legal questions, financial counseling, and more!</span></li>\n<li><span style=\"font-family: arial, helvetica, sans-serif; font-size: 12pt\">401k program</span></li>\n<li><span style=\"font-family: arial, helvetica, sans-serif; font-size: 12pt\">Comprehensive PTO and sick leave options</span></li>\n<li><span style=\"font-family: arial, helvetica, sans-serif; font-size: 12pt\">Opportunities for growth and advancement</span></li>\n<li><span style=\"font-family: arial, helvetica, sans-serif; font-size: 12pt\">Casual Fridays </span></li>\n</ul>\n<p><br></p>\n<p><span style=\"font-family: arial, helvetica, sans-serif; font-size: 12pt; font-weight: bold\">Key Responsibilities</span><br><span style=\"font-family: arial, helvetica, sans-serif; font-size: 12pt\"><em><span style=\"font-weight: bold\">Operational Leadership</span></em></span><br><span style=\"font-size: 12pt\"><span style=\"font-family: arial, helvetica, sans-serif\">• <span style=\"font-weight: bold\">Dual-Channel Billing Ownership</span>: Direct billing operations across Medical Benefit (J-Codes, HCPCS, CPT, </span><span style=\"font-family: arial, helvetica, sans-serif\">CMS-1500, UB-04) and Pharmacy Benefit (NCPDP) channels, ensuring coordinated revenue capture for </span><span style=\"font-family: arial, helvetica, sans-serif\">therapies billable under either benefit.</span></span><br><span style=\"font-size: 12pt\"><span style=\"font-family: arial, helvetica, sans-serif\">• <span style=\"font-weight: bold\">Team Leadership</span>: Lead, mentor, and develop the professional billing staff across specialty pharmacy and </span><span style=\"font-family: arial, helvetica, sans-serif\">infusion lines. Establish clear performance standards, training plans, and career pathways.</span></span><br><span style=\"font-size: 12pt\"><span style=\"font-family: arial, helvetica, sans-serif\">• Workflow Discipline: Audit and refine billing workflows to remove rework, reduce touch points, and </span><span style=\"font-family: arial, helvetica, sans-serif\">shorten the cycle from service date to clean claim submission. Implement automation where appropriate </span><span style=\"font-family: arial, helvetica, sans-serif\">for claim edits, eligibility verification, and secondary claim routing.</span></span><br><span style=\"font-size: 12pt\"><span style=\"font-family: arial, helvetica, sans-serif\">•<span style=\"font-weight: bold\"> Cash Posting Oversight</span>: Oversee pharmacy and professional medical cash posting operations, ensuring </span><span style=\"font-family: arial, helvetica, sans-serif\">accurate, timely, and fully reconciled posting of payments, adjustments, and remittances across both </span><span style=\"font-family: arial, helvetica, sans-serif\">benefit channels. Maintain controls that support clean AR aging, accurate reporting, and audit readiness.</span></span></p>\n<p><br><span style=\"font-size: 12pt\"><em><span style=\"font-family: arial, helvetica, sans-serif; font-weight: bold\">Reimbursement Integrity</span></em></span><br><span style=\"font-size: 12pt\"><span style=\"font-family: arial, helvetica, sans-serif\">• <span style=\"font-weight: bold\">Coding Accuracy and Modifier Review</span>: Conduct structured reviews of code selection, modifier application </span><span style=\"font-family: arial, helvetica, sans-serif\">(including JW, JZ, and infusion-specific modifiers), units billed, and place-of-service designations to ensure </span><span style=\"font-family: arial, helvetica, sans-serif\">each claim accurately reflects the service provided and the payer’s coverage policy.</span></span><br><span style=\"font-size: 12pt\"><span style=\"font-family: arial, helvetica, sans-serif\">• <span style=\"font-weight: bold\">Pre-Submission Validation</span>: Establish formal pre-billing audit and validation protocols, including small-</span><span style=\"font-family: arial, helvetica, sans-serif\">volume claim validation cycles to confirm payer acceptance of new codes, modifiers, or product NDCs </span><span style=\"font-family: arial, helvetica, sans-serif\">before broad submission. All validation activity is documented, evidence-based, and grounded in published </span><span style=\"font-family: arial, helvetica, sans-serif\">payer policy and contract terms.</span></span></p>\n<p><span style=\"font-size: 12pt\"><span style=\"font-family: arial, helvetica, sans-serif\">•<span style=\"font-weight: bold\"> Ancillary Service Capture</span>: Ensure all billable components of complex therapies — including nursing </span><span style=\"font-family: arial, helvetica, sans-serif\">administration, supplies, clinical monitoring, and pharmacist clinical services — are documented and </span><span style=\"font-family: arial, helvetica, sans-serif\">submitted in accordance with payer policy and AmeriPharma contracts.</span></span><br><span style=\"font-size: 12pt\"><span style=\"font-family: arial, helvetica, sans-serif\">• <span style=\"font-weight: bold\">Denial Root Cause Management</span>: Treat every denial as an actionable data point. Lead structured root-</span><span style=\"font-family: arial, helvetica, sans-serif\">cause analysis, drive upstream corrections in intake and clinical documentation, and reduce avoidable </span><span style=\"font-family: arial, helvetica, sans-serif\">denial volume cycle over cycle.</span></span></p>\n<p><br><span style=\"font-family: arial, helvetica, sans-serif; font-size: 12pt\"><em><span style=\"font-weight: bold\">Payer and Contract Alignment</span></em></span><br><span style=\"font-size: 12pt\"><span style=\"font-family: arial, helvetica, sans-serif\">• <span style=\"font-weight: bold\">Commercial Plan Expertise</span>: Apply current working knowledge of national and regional commercial payer </span><span style=\"font-family: arial, helvetica, sans-serif\">policy (Aetna, BCBS plans, UnitedHealthcare, Cigna, Humana, and others) to navigate prior authorization </span><span style=\"font-family: arial, helvetica, sans-serif\">requirements, site-of-care policy, white-bagging and brown-bagging dynamics, and benefit determination </span><span style=\"font-family: arial, helvetica, sans-serif\">rules.</span></span><br><span style=\"font-size: 12pt\"><span style=\"font-family: arial, helvetica, sans-serif\">• <span style=\"font-weight: bold\">Contract-Aware Billing</span>: Partner with Contracting to ensure billing practices reflect current network rates </span><span style=\"font-family: arial, helvetica, sans-serif\">and terms, including specialty wrap networks such as First Health, and to surface contract gaps or </span><span style=\"font-family: arial, helvetica, sans-serif\">interpretation issues that affect realized reimbursement.</span></span><br><span style=\"font-size: 12pt\"><span style=\"font-family: arial, helvetica, sans-serif\">• <span style=\"font-weight: bold\">Government Program Compliance</span>: Ensure Medicare Part B, Medicare Part D, Medicaid (FFS and MCO), and </span><span style=\"font-family: arial, helvetica, sans-serif\">dual-eligible billing follows current CMS and state-specific guidance.</span></span></p>\n<p><br><span style=\"font-family: arial, helvetica, sans-serif; font-size: 12pt\"><em><span style=\"font-weight: bold\">Compliance and Audit Readiness</span></em></span><br><span style=\"font-size: 12pt\"><span style=\"font-family: arial, helvetica, sans-serif\">• <span style=\"font-weight: bold\">Regulatory Posture</span>: Ensure billing practices remain fully compliant with OIG, HIPAA, CMS, USP, and state </span><span style=\"font-family: arial, helvetica, sans-serif\">pharmacy and Medicaid requirements. All optimization activity is documented, defensible, and supported </span><span style=\"font-family: arial, helvetica, sans-serif\">by published payer policy and contract terms.</span></span><br><span style=\"font-size: 12pt\"><span style=\"font-family: arial, helvetica, sans-serif\">• <span style=\"font-weight: bold\">Audit Response</span>: Lead internal and external billing audit responses, including payer audits, OIG inquiries, </span><span style=\"font-family: arial, helvetica, sans-serif\">and Medicaid reviews. Maintain documentation standards that withstand third-party review.</span></span></p>\n<p><br></p>\n<p><span style=\"font-family: arial, helvetica, sans-serif; font-size: 12pt; font-weight: bold\">Required Qualifications</span><br><span style=\"font-size: 12pt\"><span style=\"font-family: arial, helvetica, sans-serif\">• <span style=\"font-weight: bold\">Experience</span>: Minimum 8–10 years of progressive leadership in Specialty Pharmacy or Home Infusion </span><span style=\"font-family: arial, helvetica, sans-serif\">Revenue Cycle, with demonstrated accountability for $100M or greater in annual collections.</span></span><br><span style=\"font-size: 12pt\"><span style=\"font-family: arial, helvetica, sans-serif\">• <span style=\"font-weight: bold\">Technical Mastery</span>: Advanced expertise in Medical Benefit billing (CMS-1500 and UB-04) and Pharmacy </span><span style=\"font-family: arial, helvetica, sans-serif\">Benefit billing (NCPDP), with deep working knowledge of CPT, HCPCS, J-Codes, ICD-10, and modifier </span><span style=\"font-family: arial, helvetica, sans-serif\">application across infusion, injectable, and specialty drug categories.</span></span><br><span style=\"font-size: 12pt\"><span style=\"font-family: arial, helvetica, sans-serif\">• <span style=\"font-weight: bold\">Payer Knowledge</span>: Comprehensive understanding of national and regional commercial reimbursement </span><span style=\"font-family: arial, helvetica, sans-serif\">policy, government payer rules, prior authorization frameworks, and specialty distribution dynamics.</span></span><br><span style=\"font-size: 12pt\"><span style=\"font-family: arial, helvetica, sans-serif\">• <span style=\"font-weight: bold\">Analytical Capability</span>: Proficiency in data analytics platforms (Power BI, Tableau, Superset, or equivalent) to </span><span style=\"font-family: arial, helvetica, sans-serif\">monitor performance, identify trends, and substantiate reimbursement decisions.</span></span></p>\n<p><span style=\"font-size: 12pt\"><span style=\"font-family: arial, helvetica, sans-serif\">• <span style=\"font-weight: bold\">Education</span>: Bachelor’s degree in Finance, Healthcare Administration, Business, or related field. Master’s </span><span style=\"font-family: arial, helvetica, sans-serif\">degree or professional certification (CPC, CPB, CRCR, or equivalent) preferred.</span></span></p>\n<p><br></p>\n<p><span style=\"font-family: tahoma, arial, helvetica, sans-serif; font-size: 12pt; font-weight: bold\">AmeriPharma’s Mission Statement </span></p>\n<p><span style=\"font-family: tahoma, arial, helvetica, sans-serif; font-size: 12pt\">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!</span></p>\n<p><br></p>\n<p><span style=\"font-family: tahoma, arial, helvetica, sans-serif; font-size: 12pt; font-weight: bold\">Physical Requirements </span></p>\n<p><span style=\"font-family: tahoma, arial, helvetica, sans-serif; font-size: 12pt\">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 be able to 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<br>vision, peripheral vision, depth perception and the ability to adjust focus.</span></p>\n<p><br></p>\n<p><span style=\"font-family: tahoma, arial, helvetica, sans-serif; font-size: 12pt; font-weight: bold\">EEO Statement </span></p>\n<p><span style=\"font-family: tahoma, arial, helvetica, sans-serif; font-size: 12pt\">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.</span></p>\n<p><br></p>",
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