Director of Billing

Job Description

Job Description

Salary: $145,000 $155,000 annually, DOE

About AmeriPharma
AmeriPharma Specialty Care is a national specialty pharmacy and home infusion provider serving patients with complex and rare conditions, including IVIG and SCIG therapy, TPN, biologics, oncology support, and rare disease therapies. AmeriPharma operates accredited ambulatory infusion centers and provides home-based infusion nationwide, supported by a fully integrated intake, clinical, and revenue cycle infrastructure. The MedBox division extends AmeriPharmas mission to senior, home-based, and long-term care populations through medication adherence and multidose packaging services.

Why Join Us?

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.

At AmeriPharma, you'll have access to:

• Competitive pay and generous compensation structures
• Full benefits package including medical, dental, vision, and life that fits your lifestyle and goals
• Employee assistance program to assist with mental health, legal questions, financial counseling, and more!
• 401k program
• Comprehensive PTO and sick leave options
• Opportunities for growth and advancement
• Casual Fridays

Position Summary
AmeriPharma Specialty Care is seeking a Director of Billing to lead and elevate billing operations across both the Medical Benefit (Part B and Major Medical) and Pharmacy Benefit (Part D and PBM) channels. This leader will own end-to-end professional billing performance for specialty pharmacy, home infusion, infusion suite (AIC), and complex therapy lines, ensuring every service, supply, and medication is captured, coded, and reimbursed accurately, completely, and in full compliance with payer and regulatory requirements.

The Director is accountable for first-pass clean claim performance, reimbursement integrity, denial prevention, and the operational discipline required to convert clinical activity into realized revenue. The role partners closely with Contracting, Intake, Pharmacy Operations, Clinical, and Compliance to ensure billing practices reflect current contract terms, payer policy, and documentation standards.

Key Responsibilities
Operational Leadership
Dual-Channel Billing Ownership: Direct billing operations across Medical Benefit (J-Codes, HCPCS, CPT, CMS-1500, UB-04) and Pharmacy Benefit (NCPDP) channels, ensuring coordinated revenue capture for therapies billable under either benefit.
Team Leadership: Lead, mentor, and develop the professional billing staff across specialty pharmacy and infusion lines. Establish clear performance standards, training plans, and career pathways.
Workflow Discipline: Audit and refine billing workflows to remove rework, reduce touch points, and shorten the cycle from service date to clean claim submission. Implement automation where appropriate for claim edits, eligibility verification, and secondary claim routing.
Cash Posting Oversight: Oversee pharmacy and professional medical cash posting operations, ensuring accurate, timely, and fully reconciled posting of payments, adjustments, and remittances across both benefit channels. Maintain controls that support clean AR aging, accurate reporting, and audit readiness.

Reimbursement Integrity
Coding Accuracy and Modifier Review: Conduct structured reviews of code selection, modifier application (including JW, JZ, and infusion-specific modifiers), units billed, and place-of-service designations to ensure each claim accurately reflects the service provided and the payers coverage policy.
Pre-Submission Validation: Establish formal pre-billing audit and validation protocols, including small-volume claim validation cycles to confirm payer acceptance of new codes, modifiers, or product NDCs before broad submission. All validation activity is documented, evidence-based, and grounded in published payer policy and contract terms.

Ancillary Service Capture: Ensure all billable components of complex therapies including nursing administration, supplies, clinical monitoring, and pharmacist clinical services are documented and submitted in accordance with payer policy and AmeriPharma contracts.
Denial Root Cause Management: Treat every denial as an actionable data point. Lead structured root-cause analysis, drive upstream corrections in intake and clinical documentation, and reduce avoidable denial volume cycle over cycle.

Payer and Contract Alignment
Commercial Plan Expertise: Apply current working knowledge of national and regional commercial payer policy (Aetna, BCBS plans, UnitedHealthcare, Cigna, Humana, and others) to navigate prior authorization requirements, site-of-care policy, white-bagging and brown-bagging dynamics, and benefit determination rules.
Contract-Aware Billing: Partner with Contracting to ensure billing practices reflect current network rates and terms, including specialty wrap networks such as First Health, and to surface contract gaps or interpretation issues that affect realized reimbursement.
Government Program Compliance: Ensure Medicare Part B, Medicare Part D, Medicaid (FFS and MCO), and dual-eligible billing follows current CMS and state-specific guidance.

Compliance and Audit Readiness
Regulatory Posture: Ensure billing practices remain fully compliant with OIG, HIPAA, CMS, USP, and state pharmacy and Medicaid requirements. All optimization activity is documented, defensible, and supported by published payer policy and contract terms.
Audit Response: Lead internal and external billing audit responses, including payer audits, OIG inquiries, and Medicaid reviews. Maintain documentation standards that withstand third-party review.

Required Qualifications
Experience: Minimum 810 years of progressive leadership in Specialty Pharmacy or Home Infusion Revenue Cycle, with demonstrated accountability for $100M or greater in annual collections.
Technical Mastery: Advanced expertise in Medical Benefit billing (CMS-1500 and UB-04) and Pharmacy Benefit billing (NCPDP), with deep working knowledge of CPT, HCPCS, J-Codes, ICD-10, and modifier application across infusion, injectable, and specialty drug categories.
Payer Knowledge: Comprehensive understanding of national and regional commercial reimbursement policy, government payer rules, prior authorization frameworks, and specialty distribution dynamics.
Analytical Capability: Proficiency in data analytics platforms (Power BI, Tableau, Superset, or equivalent) to monitor performance, identify trends, and substantiate reimbursement decisions.

Education: Bachelors degree in Finance, Healthcare Administration, Business, or related field. Masters degree or professional certification (CPC, CPB, CRCR, or equivalent) preferred.

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 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 performingthe 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
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 on the basis of disability or any other legally protected class.