Position Summary
The Business Office Manager (BOM) is responsible for overseeing the financial and administrative functions of the facility to ensure residents receive necessary services while maintaining accurate billing, reimbursement, and regulatory compliance. This role serves as a liaison between residents, families, insurance providers, government payors, and facility departments to facilitate timely payment for services, protect resident funds, and support uninterrupted access to care.
Essential Duties and Responsibilities
Billing & Reimbursement
- Manage resident accounts and oversee billing for services provided within the facility.
- Ensure accurate and timely submission of claims to Medicare, Medicaid, managed care organizations, and other insurance providers.
- Monitor accounts receivable and follow up on outstanding balances, denied claims, and reimbursement issues.
- Review payer requirements and coordinate with clinical departments to ensure supporting documentation meets billing standards.
- Work with corporate billing partners, insurance companies, and government agencies to resolve payment discrepancies.
Insurance & Eligibility Management
- Verify insurance coverage and benefits for admissions, continued stays, and changes in level of care.
- Monitor resident eligibility for Medicare, Medicaid, managed care plans, and other funding sources.
- Assist residents and families with Medicaid applications, redeterminations, spend-down requirements, and other financial eligibility processes.
- Ensure authorizations, certifications, and payer requirements are obtained and maintained to prevent interruptions in coverage.
Resident Trust Fund Management
- Maintain and safeguard resident trust accounts in accordance with federal and state regulations.
- Process deposits, withdrawals, personal spending requests, and account reconciliations.
- Provide accurate trust account statements to residents and responsible parties.
- Ensure resident funds are managed ethically, accurately, and in compliance with regulatory requirements.
Financial Operations
- Manage resident financial records and maintain accurate account documentation.
- Collect and post payments from residents, families, and third-party payors.
- Prepare reports related to accounts receivable, collections, trust funds, and census-related financial data.
- Support facility audits and provide requested financial documentation.
Interdepartmental Coordination
- Collaborate with Admissions, Nursing, Therapy, Social Services, Medical Records, and MDS departments to ensure services are appropriately documented and reimbursable.
- Participate in care conferences and discharge planning discussions when financial or payer issues impact resident care.
- Communicate with residents and families regarding financial responsibilities, insurance coverage, and payment arrangements.
- Assist leadership in identifying barriers to reimbursement and implementing corrective actions.
Compliance & Regulatory Responsibilities
- Maintain compliance with Medicare, Medicaid, state, federal, and facility regulations.
- Ensure resident financial information is handled confidentially and in accordance with HIPAA requirements.
- Participate in audits, surveys, and quality assurance activities related to business office operations.
- Stay current on reimbursement regulations, payer requirements, and industry best practices.
Qualifications
- Previous experience in skilled nursing facility business office operations, healthcare billing, insurance verification, or revenue cycle management preferred.
- Knowledge of Medicare, Medicaid, managed care reimbursement, and long-term care regulations.
- Experience managing resident trust funds and accounts receivable preferred.
- Strong organizational, customer service, problem-solving, and communication skills.
- Ability to work collaboratively with residents, families, payors, and interdisciplinary teams.
- Proficiency in Microsoft Office and healthcare billing or electronic medical record systems.
Pay: From $60,000.00 per year
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Health insurance
- Vision insurance
Work Location: In person
