Head of Billing and Collections- Fuze Rx

Job Description

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.

• 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.
• Maintains 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.

Qualifications And Skills

• Experience: 10+ years overall billing, collection, and AR management, with 3 - 5+ years of experience in medical/pharmacy billing and team leadership.
• Knowledge: Strong understanding of pharmacy adjudication systems and third-party payer rules.
• Technical Skills: Proficiency in pharmacy management software, preferably Inmar, and Microsoft Excel.
• Performance Management: Demonstrated track record of driving operational excellence and delivering high-quality results.
• Soft Skills: Strong analytical, problem-solving, and communication skills, with the ability to lead in a fast-paced environment.

Preferred Requirements

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