Medicaid Specialist and Nursing Home Business Office Manager (BOM)

Rose Mountain Care Center is looking for an experienced and qualified Business Office Manager (BOM). The Business Office Manager (BOM) is responsible for managing the daily business and financial operations of the facility. This includes overseeing billing and collections, resident trust funds, accounts payable, and financial reporting. The BOM ensures compliance with federal, state, and local regulations as well as company policies and procedures. The BOM has experience in NJ Medicaid applications and renewals, managing payer trees in PCC, managing resident PNA, excellent organizational skills, and a commitment to providing superior customer service to residents, families, and staff.

Job Responsibilities:

• Respond promptly and professionally to and follow up with all inquiries timely and appropriately via phone, email, and in-person.

• Contact all necessary departments to retrieve data for updating Census relating to recent admissions and/or discharges.

• Manging and overseeing the payer trees in the EMR (PCC)

• Verify insurance (Medicare/Medicaid/Managed Care).

• Disenroll and reinroll residents from their Managed Medicare Plans

• Requesting Authorizations from Insurance for In-House Residents

• Assist with Medicaid applications and collecting necessary information and documents.

• Knowledgeable in all governement regulations in regards to medicaid eligbilty.

• Manages resident funds.

• Troubleshoot any problem claims e.g., denied payments, incorrect data, etc.

• Prepare, process, and send monthly private pay resident billing statements.

• Prepare, process, and send monthly privately insured (e.g., co-insurance, Aetna, BlueCross/Blue Shield) resident billing statements.

• Update Medicare tracking form pertaining to bad debts (as need for cost reporting analysis).

• Prepare and distribute monthly a completed census to all vendors

• Maintenance of resident files (e.g., retiring of files for past residents).

• Assists, when needed, in posting cash receipts.

• Manage weekly aging reports and collection calls.

• Follow all safety and security procedures with entrance doors.

• Contacts department heads and senior leadership in a timely manner to inform of facility problems or emergencies.

• Interact with clients and facility staff with professionalism in all facets of customer service.

• Escalate growing balances and/or unresolved time sensitive issues.

• Ensure facility is operating according to established procedures and in compliance with applicable regulations.

• Participate in team meetings, committees, and/or conference calls.

• Ensure adherence to all applicable laws, including HIPAA, CMS, and state licensing regulations.

• Collaborate with team members to meet or exceed department goals

• Keep immediate supervisor informed daily of all work activity.

• Interact professionally and effectively with all levels of the organization, residents, family members, etc.

• Perform all duties in compliance with all applicable federal and state rules and regulations and facility policies and procedures in a timely manner.

• Exemplify quality of care and advocate for the customer experience.

• Interact cooperatively with residents, families, visitors, and other staff.

• Accept assigned duties in a cooperative manner and perform duties as assigned by appropriate personnel.

• Assists in any other function within the department at the discretion of the Administrator or supervisor.

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