Director of Billing

This is a fully remote position, open to applicants in Florida.

📋 Description

• Lead the creation and implementation of uniform billing and reimbursement playbooks for all clients.

• Collaborate with the technology team to establish billing enablement requirements, such as denial tracking, reimbursement analytics, and claims workflow visibility.

• Provide strategic oversight for billing and reimbursement operations across various client organizations.

• Act as the subject matter expert in infusion billing and reimbursement within the RCM organization.

• Create standardized best practices for infusion billing, coding, and revenue cycle management processes.

• Mentor promising associates and billing personnel.

• Advise clients on billing and reimbursement issues and serve as the primary escalation point.

• Assist with monthly business reviews focusing on financial performance, reimbursement trends, and optimization strategies.

• Suggest improvements for payor contracting, drug acquisition/reimbursement, and overall program financial efficiency.

• Conduct research on client performance, analyze trends, and propose enhancements.

• Align drug acquisition strategies with reimbursement and GPO performance metrics.

• Assess billing readiness and downstream claims workflows to identify reimbursement risks.

• Enhance reimbursement processes for infusion medications, administration services, and relevant supplies.

• Support billing and documentation strategies specific to payors.

• Provide expertise on billing pathways for medical versus pharmacy benefits.

• Collaborate with intake and RCM leadership to convert verified referrals into precise claims.

• Guide infusion billing processes involving HCPCS/J-codes, NDCs, infusion administration CPT codes, drug wastage, and modifiers.

• Resolve intricate payor reimbursement challenges and establish escalation protocols for billing and denial trends.

• Monitor revenue cycle metrics, including drug reimbursement, denials, days in A/R, and revenue per infusion visit.

• Develop data-driven plans for operational improvements and performance monitoring tools.

• Ensure adherence to payor requirements, CMS guidelines, OIG recommendations, and industry best practices.

• Support audit readiness for billing and claims documentation.

• Create training materials, competency frameworks, and operational protocols.

• Identify inefficiencies in billing and claims processes and implement standardized, scalable solutions through automation, technology adoption, and workflow redesign.

⛳️ Requirements

• High school diploma or equivalent.

• Over 5 years of experience in healthcare, with substantial experience in infusion services billing and reimbursement for both pharmacy and medical benefits.

• More than 3 years of leadership or managerial experience.

• Strong knowledge of infusion reimbursement, payor policies, and revenue cycle workflows.

• Experience in outpatient infusion centers, specialty pharmacies, oncology infusion, or hospital-based infusion services.

• Proven experience managing multi-site or multi-client environments.

• In-depth understanding of infusion billing operations and reimbursement models.

• Strong abilities in strategic thinking and operational leadership.

• Excellent skills in client relationship management and executive communication.

• Capability to analyze financial and claims performance metrics.

• Strong problem-solving and process improvement abilities.

• Ability to handle multiple client engagements simultaneously.

🏝️ Benefits

• Health insurance.

• Dental insurance.

• Vision insurance.

• Life insurance.

• 401(k).

• Paid time off.

• Remote work with limited travel to client locations, internal business meetings, and other necessary locations.