A Clinical Office Manager manages a clinical office in a hospital or other clinical program. Works with the clinic director and other clinicians. Manages clinic business operations and office administration including scheduling, bookkeeping, billing, patient records, equipment and supply orders.
As the Business Office Manager, you serve as the central financial and operational driver for our Massachusetts skilled nursing facility. You will oversee all business office functions across both our Sub-Acute Unit and our resident-centered Long-Term Care Units. In this role, you will lead end-to-end revenue cycle management—with specialized oversight of MassHealth (Massachusetts Medicaid), Medicare Part A/B, Accountable Care Organizations (ACOs), Senior Care Options (SCO/One Care), Managed Care, and Private Pay. You will ensure full compliance with Executive Office of Health and Human Services (EOHHS) regulations, manage local office personnel, and act as a compassionate financial resource for residents and their families.
Key Responsibilities:
MassHealth Multi-Payer Revenue Cycle Management:
Oversee full-scope billing operations across all primary payers: MassHealth Standard, Senior Care Options (SCO), Medicare Part A B, Commercial Managed Care, and Private Pay. Direct the MassHealth Application Pending pipeline: track long-term care applications through local MassHealth Enrollment Centers (MEC), submit required verification documentation, and monitor eligibility determinations. Manage and audit Patient-Paid Amount (PPA / NAMI) calculations, ensuring accurate billing and prompt collection of resident liability amounts while maintaining Personal Needs Allowance (PNA) balances in strict accordance with Massachusetts regulations. Coordinate pre-authorizations, Level
I/II PASRR
screens, and clinical clearance for short-stay sub-acute admissions to minimize claim denials. Submit timely claims and resolve billing edits through MMIS (Virtual Gateway) and clearinghouses; manage accounts receivable (A/R) aging reports, write-offs, and collections. Maintain resident trust accounts (PNA) in compliance with MassHealth regulations, state auditing standards, and 101 CMR guidelines.
General Accounting Facility Budgeting:
Reconcile facility checkbooks, post daily receipts, and manage local accounts payable/petty cash. Oversee payroll processing and verify timekeeping data in coordination with department heads. Partner with the Executive Director to monitor operating expenses, labor metrics, and departmental spend against the facility budget.
Team Leadership Interdisciplinary Collaboration:
Recruit, hire, train, evaluate, and supervise business office personnel (e.g., A/R Specialists, Payroll Coordinators, Receptionists). Work closely with Admissions, Social Services, and Case Management to streamline MassHealth spend-downs, payer authorizations, and discharge financial wrap-ups. Serve as the primary liaison during state financial audits, MassHealth reviews, and annual cost report preparation support.
Compliance, Ethics Family Support:
Ensure strict adherence to MassHealth regulations, CMS rules, HIPAA privacy standards, and Massachusetts Department of Public Health (DPH) guidelines. Guide short-stay rehab patients and long-term care families through complex billing statements, MassHealth eligibility rules, and financial paperwork with clarity and empathy. Participate in facility leadership meetings, regulatory audits, and safety/emergency protocols (including resident evacuation procedures when required).
Qualifications Requirements:
Education:
Associate's or Bachelor's degree in Healthcare Administration, Accounting, Business Administration, or equivalent hands-on SNF experience.
Experience:
Minimum 2-3 years of business office or billing experience inside a Massachusetts Skilled Nursing Facility (SNF). Deep, hands-on experience navigating MassHealth (Medicaid) application, approval, and spend-down processes for long-term care residents. Proven track record managing MMIS / Virtual Gateway, Medicare, Managed Care, and SCO/ICO billing workflows.
Specialized Knowledge Skills:
High proficiency with SNF billing software (e.g., PointClickCare, MatrixCare, or similar systems integrated with Massachusetts billing requirements). In-depth understanding of Massachusetts MassHealth regulations (e.g., PNA allowances, Community Spouse rules, and
PPA/NAMI
reconciliation). Demonstrated leadership capability, strong organizational skills, and exceptional empathy when communicating with families navigating long-term care finances. An Equal Opportunity Employer
