Head of Billing and Collections- Fuze Rx

Fuze Health•New York, NV

3d•Remote

About The Position

The Head of Billing and Collections is responsible for overseeing the daily operations of the billing and collections department, ensuring accurate and timely submission of claims and invoices, managing revenue cycle processes, and leading a team to maximize collections. This leadership role focuses on reducing claim denials, managing payments per payer contracts, and optimizing cash collections in a high-volume setting. You will oversee a team of professionals dedicated to ensuring the efficient and effective delivery of patient support services and revenue cycle management. You will lead initiatives to optimize operations, drive continuous improvement, and ensure compliance with regulations while fostering a collaborative and high-performance environment.

Requirements

10+ years overall billing, collection, and AR management, with 3 - 5+ years of experience in medical/pharmacy billing and team leadership.
Strong understanding of pharmacy adjudication systems and third-party payer rules.
Proficiency in pharmacy management software, preferably Inmar, and Microsoft Excel.
Demonstrated track record of driving operational excellence and delivering high-quality results.
Strong analytical, problem-solving, and communication skills, with the ability to lead in a fast-paced environment.
Ability to work at a computer terminal with monitor, keyboard and mouse for extended periods of time, stoop, bend, and reach for equipment and supplies, make frequent repetitive motions required to operate a computer that include the wrists, hands and fingers, and lift, carry, push, pull, and move light objects up to 20 pounds.
Ability to effectively communicate through verbal interactions, discern auditory information, and visually perceive details to perform essential job functions.
Applicants must be authorized to work for any employer in the U.S.

Nice To Haves

Bachelor’s degree in Business, Finance, or Healthcare Administration or related field.
Experience with 340B claims management

Responsibilities

Supervises billing and AR staff, assigning daily work, training new employees, and mentoring team members on billing techniques.
Develops and implements policies, procedures, and best practices to improve billing efficiency and revenue integrity.
Monitors AR aging reports to identify and resolve delinquent accounts, underpayments, and denials.
Manages the resolution of rejected claims, submits appeals for denied claims, and reconciles pharmacy payments.
Ensures compliance with HIPAA, state/federal regulations, and payer contracts (Medicare, Medicaid, commercial).
Generates and analyzes financial reports, tracking key performance metrics for pharmacy leadership.
Serves as a liaison between the pharmacy staff, finance department, and insurance payers regarding billing issues.

Benefits

dental
vision
multiple group medical plans to choose from
a 401(k) retirement savings plan
group life insurance
accidental death and dismemberment (AD&D) insurance
flexible spending account (FSA)
health savings account (HSA)
commuter benefits
employer-paid short-term (STD) and long-term disability (LTD) insurance
additional supplemental insurance plans (spouse life insurance, legal insurance, an employee assistance program, home health testing kits, and a fertility medication discount program)
flexible vacation time
accrued paid sick time
10 paid holidays
(2 floating holidays for full time non-exempt employees)
eight weeks of paid parental leave for eligible employees
additional paid weeks for the birthing parent
4 weeks paid caregiver leave
a Lifestyle Spending Account allowance each month