Business Office Manager

Business Office Manager / HR

Position summary

We are looking for a Business Office Manager who runs the financial side of the building and serves as our on-site HR lead. You will own resident billing, collections and trust accounts, and you will also be the person staff come to for payroll, onboarding, benefits and personnel files.

This role suits someone who likes variety, knows long-term care reimbursement, and can switch from a Medicaid pending list to a new-hire orientation in the same afternoon. You will work closely with the Administrator, Director of Nursing, Admissions and department heads, and you will be part of the facility's leadership team.

Details:

Department - Business Office / Administration

Reports to - Administrator

Status - Full-time, exempt

Schedule - Monday–Friday, day shift; occasional evenings or weekends for payroll deadlines, surveys or orientation

Business office responsibilities

Billing and revenue cycle

• Prepare and submit timely, accurate claims for Medicare Part A and B, Medicaid, Managed Care/Medicare Advantage, private insurance, hospice and private pay.
• Run monthly billing close, including the triple check process with Nursing, MDS and Therapy before Medicare claims go out.
• Verify insurance eligibility and benefits at admission and monthly; obtain and track authorizations for managed care residents.
• Post payments and adjustments accurately and reconcile deposits to the bank.

Accounts receivable and collections

• Manage the AR aging and work every payer bucket to keep days in AR and bad debt within company targets.
• Follow up on denied, rejected and pending claims; file appeals and rebills as needed.
• Contact residents and responsible parties about balances, set up payment plans, and escalate accounts per policy.
• Lead the monthly AR meeting with the Administrator and report on collections progress.

Medicaid and financial eligibility

• Assist residents and families with Medicaid applications, redeterminations and required documentation.
• Track Medicaid pending accounts through approval, and calculate and collect patient liability (share of cost).
• Coordinate with Admissions on payer source and financial screening before admission.

Resident trust fund

• Manage resident trust accounts in compliance with federal and state regulations, including quarterly statements, interest posting and timely conveyance at discharge or death.
• Monitor balances against Medicaid resource limits and notify residents or representatives as required.

Census, reporting and office operations

• Reconcile daily census with Nursing and Admissions so billing reflects accurate payer, level of care and leave days.
• Prepare month-end reports, accounts payable support and petty cash reconciliation as directed.
• Maintain business office files, admission agreements and financial records in an organized, audit-ready state.
• Supervise and train business office and front desk staff.

Human resources responsibilities

Payroll and timekeeping

• Process biweekly payroll accurately and on time, including time-clock review, missed punches, overtime, shift differentials, PTO and bonuses.
• Audit timecards with department heads and correct errors before payroll closes.
• Enter new hires, terminations, pay changes and deductions in the payroll system.
• Submit Payroll-Based Journal (PBJ) staffing data to CMS each quarter and reconcile it to payroll hours.

Recruiting and onboarding

• Post open positions, screen applicants and schedule interviews with hiring managers.
• Complete pre-employment requirements: background checks, state abuse and nurse aide registry checks, OIG exclusion screening, license and certification verification, drug screens and TB testing.
• Complete I-9 and E-Verify, tax forms and new-hire paperwork.
• Coordinate new-hire orientation and make sure required training is completed before staff work on the floor.

Employee records and compliance

• Maintain complete, confidential personnel files that are survey-ready at all times.
• Track license and certification expirations, annual competencies, in-service hours, health screenings and annual evaluations.
• Run monthly OIG and state exclusion checks for all employees.
• Keep required labor law postings current and support compliance with FMLA, ADA, wage and hour, and state employment laws.

Qualifications

Required

• High school diploma or equivalent.
• 3 years of business office experience in a skilled nursing facility or long-term care setting.
• Working knowledge of Medicare, Medicaid and managed care billing for long-term care.
• Experience processing payroll for hourly staff.
• Proficiency with Excel and an EHR/billing system such as PointClickCare, MatrixCare or similar.

Skills that make someone great in this role

• Accuracy and follow-through with numbers, deadlines and paperwork.
• Discretion with confidential resident, financial and employee information.
• Comfort talking about money with families in a compassionate, professional way.
• Ability to juggle billing deadlines, payroll and staff questions without dropping details.
• Approachable, steady presence for frontline staff.

This description reflects the main duties of the role and is not an exhaustive list. Other duties may be assigned as needed.

Pay: $47,840.00 - $58,240.00 per year

Work Location: In person

Salary : $47,840 - $58,240