Business Office Manager

The Business Office Manager is responsible for overseeing and coordinating the daily financial and administrative business office operations of the Skilled Nursing Facility (SNF) and Home Health services within Hill View Continuing Care Retirement Community.

This position ensures the accurate and timely processing of resident and patient billing, Medicare and Medicaid reimbursement, accounts receivable, collections, financial records, and related business office functions.

The Business Office Manager works collaboratively with facility administration, nursing leadership, admissions, social services, home health personnel, and other departments to maintain financial accountability, maximize appropriate reimbursement, ensure regulatory compliance, and provide exceptional customer service to residents, patients, and families.

ESSENTIAL DUTIES AND RESPONSIBILITIES

1. Business Office Management

• Oversee the daily operations of the business office for the Skilled Nursing Facility and Home Health services.

• Establish and maintain efficient billing, collection, recordkeeping, and financial reporting procedures.

• Ensure accurate and timely completion of assigned financial and administrative functions.

• Supervise, train, and evaluate business office personnel, as assigned.

• Maintain appropriate internal controls to safeguard organizational financial information and assets.

• Coordinate with administration and accounting personnel regarding financial performance and operational concerns.

• Identify opportunities to improve business office efficiency, reimbursement processes, and revenue cycle performance.

2. Medicare and Medicaid Billing and Reimbursement

• Oversee the preparation, submission, and follow-up of Medicare, Medicaid, managed care, private insurance, and private-pay claims.

• Ensure billing accuracy and compliance with applicable federal and Ohio reimbursement requirements.

• Monitor Medicare Part A and Part B billing processes applicable to skilled nursing services.

• Oversee Medicaid billing, eligibility verification, patient liability, and reimbursement processes.

• Coordinate with Home Health personnel to ensure appropriate Medicare, Medicaid, and commercial insurance billing.

• Monitor rejected, denied, and unpaid claims and coordinate timely resolution.

• Maintain familiarity with Medicare SNF Prospective Payment System (PDPM) and Home Health Prospective Payment System (PDGM) reimbursement requirements.

• Collaborate with clinical personnel to ensure required documentation supports accurate billing and reimbursement.

• Monitor changes in reimbursement regulations and communicate relevant changes to administration.

3. Accounts Receivable and Collections

• Oversee accounts receivable activities for the Skilled Nursing Facility and Home Health operations.

• Review accounts receivable aging reports regularly and identify delinquent accounts.

• Establish and implement appropriate collection procedures consistent with applicable laws and organizational policies.

• Follow up with insurance companies, government payers, residents, patients, and responsible parties regarding outstanding balances.

• Investigate and resolve billing discrepancies, payment delays, and account disputes.

• Coordinate payment arrangements when appropriate and authorized.

• Prepare monthly accounts receivable reports and communicate collection concerns to administration.

• Monitor collection trends, bad debt exposure, and outstanding claims to support financial stability.

• Ensure collection practices respect resident and patient rights and applicable limitations on third-party financial liability.

4. Resident and Patient Financial Accounts

• Maintain accurate resident and patient financial records, including charges, payments, adjustments, and outstanding balances.

• Coordinate financial aspects of admissions, discharges, transfers, and payer changes.

• Explain billing procedures, payment obligations, insurance coverage, and financial policies to residents, patients, and authorized representatives.

• Assist residents and families with Medicaid application and renewal processes, including coordination of required financial documentation.

• Monitor Medicaid eligibility and pending applications to minimize interruptions in reimbursement.

• Coordinate with admissions and social services to identify potential financial barriers and resolve account concerns.

• Ensure appropriate documentation of financial agreements and payer information.

• Maintain confidentiality of resident and patient financial information.

5. Home Health Business Office Operations

• Oversee business office functions specific to Home Health services.

• Coordinate with Home Health clinical leadership to ensure timely and accurate submission of claims.

• Monitor billing requirements related to physician or allowed-practitioner orders, certifications, plans of care, and other required documentation.

• Coordinate financial processes associated with start-of-care, recertification, discharge, and changes in payer coverage.

• Monitor claim submission, reimbursement, denials, and outstanding accounts.

• Maintain accurate patient account records and payer information.

• Assist with financial reporting and reimbursement analysis for Home Health operations.

• Identify and resolve billing issues in collaboration with Home Health management.

6. Financial Reporting and Reconciliation

• Prepare and review monthly billing, collection, and accounts receivable reports.

• Reconcile resident and patient accounts and investigate discrepancies.

• Monitor revenue cycle performance and identify opportunities to improve cash collections.

• Assist administration and accounting personnel with monthly financial close processes.

• Provide financial data and supporting documentation for audits, cost reports, and reimbursement reviews.

• Monitor financial performance indicators, including accounts receivable aging, collection rates, and outstanding claims.

• Assist in the preparation of budgets, financial projections, and operational reports as requested.

• Coordinate accurate recording and reconciliation of payments, deposits, and adjustments.

7. Regulatory Compliance and Documentation

• Ensure business office operations comply with applicable Medicare, Medicaid, HIPAA, and Ohio regulatory requirements.

• Maintain accurate and complete financial records in accordance with organizational policies and record retention requirements.

• Assist with financial documentation requested during regulatory surveys, audits, and reviews.

• Support compliance with resident trust fund requirements when such responsibilities are assigned.

• Maintain appropriate separation of duties and financial controls.

• Monitor regulatory changes affecting billing, reimbursement, and resident financial responsibilities.

• Report suspected billing irregularities, financial discrepancies, or compliance concerns to administration.

• Participate in compliance training and organizational quality improvement initiatives.

8. Communication and Customer Service

• Serve as a primary resource for residents, patients, families, and authorized representatives regarding billing and financial account questions.

• Respond professionally and promptly to financial inquiries and concerns.

• Coordinate with nursing, therapy, admissions, social services, and Home Health personnel to resolve reimbursement and billing issues.

• Maintain effective working relationships with insurance companies, government agencies, vendors, and other external organizations.

• Communicate significant financial issues, reimbursement delays, and collection concerns to administration.

• Demonstrate professionalism, discretion, compassion, and confidentiality in all interactions.

REQUIRED QUALIFICATIONS

Education

• High school diploma or equivalent required.

• Associate's or bachelor's degree in Accounting, Business Administration, Healthcare Administration, Finance, or a related field preferred.

Experience

• Minimum of three years of business office, billing, accounts receivable, or financial administration experience required.

• Experience in a skilled nursing facility, long-term care, home health, or comparable healthcare setting strongly preferred.

• Experience with Medicare and Medicaid billing and reimbursement preferred.

• Prior supervisory or business office management experience preferred.

Knowledge, Skills, and Abilities

• Working knowledge of Medicare, Medicaid, managed care, and private insurance billing procedures.

• Understanding of healthcare accounts receivable and collection practices.

• Strong organizational, analytical, and problem-solving skills.

• Proficiency in Microsoft Excel, Word, and business office software.

• Ability to interpret financial reports and identify discrepancies.