Head of Billing and Collections- Fuze Rx

Overview

The organization is seeking a Head of Billing and Collections to lead the billing and collections department. This role involves overseeing daily operations, ensuring accurate and timely claim submissions, managing revenue cycle processes, and leading a team to maximize collections. The position focuses on reducing claim denials, managing payments according to payer contracts, and optimizing cash collections in a high-volume environment.

Responsibilities

• Supervise billing and accounts receivable (AR) staff, assign daily work, train new employees, and mentor team members on billing techniques.
• Develop and implement policies, procedures, and best practices to improve billing efficiency and revenue integrity.
• Monitor AR aging reports to identify and resolve delinquent accounts, underpayments, and denials.
• Manage resolution of rejected claims, submit appeals for denied claims, and reconcile pharmacy payments.
• Ensure compliance with HIPAA, state and federal regulations, and payer contracts including Medicare, Medicaid, and commercial payers.
• Generate and analyze financial reports, tracking key performance metrics for pharmacy leadership.
• Serve as a liaison between pharmacy staff, finance department, and insurance payers regarding billing issues.

Key Performance Indicators (KPIs)

• Reduced Days Sales Outstanding (DSO) in Accounts Receivable.
• High first-pass claim acceptance rates.
• Minimal write-offs and bad debt.
• Improved denial resolution turnaround time.

Qualifications and Skills

• Minimum 10 years of experience in billing, collections, and AR management.
• At least 3 to 5 years of experience in medical or 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 ability to drive operational excellence and deliver high-quality results.
• Strong analytical, problem-solving, and communication skills.
• Ability to lead effectively in a fast-paced environment.

Preferred Qualifications

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

Physical Requirements

• Ability to work at a computer terminal with monitor, keyboard, and mouse for extended periods.
• Ability to stoop, bend, reach for equipment and supplies.
• Ability to perform frequent repetitive motions involving wrists, hands, and fingers.
• Ability to lift, carry, push, pull, and move light objects up to 20 pounds.
• Effective verbal communication, auditory discernment, and visual perception to perform essential job functions.

Reasonable accommodations will be provided to qualified individuals with disabilities in accordance with the Americans with Disabilities Act (ADA) and applicable state laws.

Compensation and Benefits

• Salary range: $110,400 to $138,000 annually.
• No commission eligibility.
• Full-time employee benefits include dental, vision, multiple group medical plans, 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 and long-term disability insurance, and supplemental insurance plans.
• Additional benefits include flexible vacation time, accrued paid sick time, 10 paid holidays (plus 2 floating holidays for full-time non-exempt employees), eight weeks of paid parental leave for eligible employees (additional paid weeks for birthing parent), four weeks paid caregiver leave, and a monthly Lifestyle Spending Account allowance.

Location Requirements

• Candidates must reside in one of the following states: Alabama, Arizona, Arkansas, California, Colorado, Connecticut, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Vermont, Virginia, Washington, Wisconsin.

Employment Authorization

Applicants must be authorized to work for any employer in the U.S. The organization does not sponsor or transfer any visa types at this time.

Equal Opportunity

The employer is an Equal Opportunity Employer. All qualified applicants will receive consideration without regard to race, color, national origin, religion, sex, gender identity, sexual orientation, age, disability, veteran status, or any other legally protected basis. Reasonable accommodations are available for applicants with disabilities during the application and hiring process.

Additional Information

Background checks are conducted consistent with applicable laws, including Fair Chance laws in California, Los Angeles County, San Francisco, Philadelphia, and New York City. The employer participates in E-Verify.

Automated decision tools may be used to assist recruiters and hiring managers in identifying candidates who match job requirements, but hiring decisions involve human review and input.

The application deadline is June 16, 2026, subject to extension based on business needs.