Business Office Director

San Francisco Campus for Jewish Living•San Francisco, CA

21h•Onsite

About The Position

The Business Office Director oversees day-to-day billing, collections, cash posting, and resident account operations for the San Francisco Campus for Jewish Living (SFCJL). The Director leads Patient Financial Services (PFS) staff and ensures claims are submitted accurately and promptly, payments are posted correctly, and accounts receivable are actively managed across payer types. The role is a key financial resource for residents and families and collaborates with Admissions, Case Management, MDS, Accounting, and other departments to support complete billing information, revenue cycle performance, and compliance with reimbursement requirements. The Director manages billing and claims, cash posting and reconciliation, denials and appeals, accounts receivable and collections, resident and family accounts, eligibility and admissions support, reporting, revenue cycle operations, staff development, and compliance. The position supervises and trains billing and collections staff, maintains procedures, and ensures billing and resident account activities comply with applicable CMS, Medicare, Medi-Cal, HIPAA, and organizational requirements.

Requirements

Associate degree in Business, Accounting, Healthcare Administration, or a related field, or equivalent relevant work experience.
At least three years of healthcare billing and collections experience, including at least two years supervising business office staff.
Working knowledge of Medicare, Medi-Cal, and managed care billing requirements for skilled nursing or long-term care and acute geriatric psychiatric care.
Experience managing accounts receivable and collection activities.
Proficiency with billing software and electronic health record systems.
Strong understanding of healthcare billing, claims submission, reimbursement, collections, and revenue cycle processes.
Strong customer service skills and ability to communicate effectively with residents, families, payers, and internal stakeholders.
Ability to manage multiple priorities, deadlines, and operational responsibilities simultaneously.
Strong organizational, analytical, problem-solving, and communication skills.
Ability to maintain confidentiality and appropriately handle sensitive financial and resident information.

Nice To Haves

Bachelor’s degree in Business, Accounting, Finance, Healthcare Administration, or a related field.
Experience with PointClickCare (PCC) and Inovalon.
Experience in a nonprofit, geriatric, senior living, skilled nursing, or related healthcare environment.
Experience managing a resident trust fund.
Revenue cycle certification, such as Certified Revenue Cycle Representative (CRCR).

Responsibilities

Oversee timely and accurate generation and submission of claims to Medicare, Medi-Cal, and managed care payers, including crossover claims for dual-eligible residents.
Maintain a clean claim rate above 95% and ensure claims are submitted within five days of the billing cycle.
Participate in the monthly Triple Check process with Nursing, MDS, and Case Management to confirm charges and supporting documentation before claims are released.
Ensure payer-specific billing requirements are followed and coordinate resolution of missing, incomplete, or inconsistent billing information.
Oversee posting of ERA and EOB payments in PointClickCare and ensure payments are applied to appropriate accounts.
Identify underpayments, overpayments, and rejected payments and escalate significant payer issues to the Chief Financial Officer.
Collaborate with Accounting to reconcile monthly cash receipts to bank activity and the general ledger.
Review remittance advice for denied, rejected, or delayed payments and ensure technical rejections are corrected and resubmitted.
File and track payer appeals, including Medicare redeterminations and Medi-Cal TAR denials.
Monitor and report denial root causes and identify recurring issues requiring staff education, workflow changes, or process improvements.
Work toward maintaining a denial rate below 5%.
Review accounts receivable aging reports weekly and prioritize collections by payer and aging category.
Ensure follow-up occurs on outstanding claims older than 30 days.
Maintain payer-based biller assignments and review individual portfolios for unresolved or aging balances.
Work toward maintaining days in accounts receivable below 45 days and resolving 98% of collectible balances within 90 days.
Provide aged accounts receivable and collectability assessments for bad-debt reserves and year-end audits.
Issue monthly private-pay statements and serve as a primary contact for residents, families, and responsible parties about billing and account questions.
Establish payment plans and apply the charitable care policy when appropriate.
Manage the resident trust fund in accordance with federal and state requirements.
Oversee petty cash and on-site payment collections.
Partner with Admissions to verify insurance eligibility and coverage at admission and monthly using payer portals and eligibility tools.
Confirm authorizations, payer information, financial classifications, and billing types are accurately established in PointClickCare.
Prepare monthly business office reports for the Chief Financial Officer, including collections, accounts receivable aging, denials, payer mix, and days in accounts receivable.
Represent Patient Financial Services on the Revenue Cycle Team.
Support PointClickCare optimization, workflow improvements, and staff training.
Supervise, schedule, train, and develop billing and collections staff.
Establish work procedures and hold staff accountable for performance goals.
Maintain current business office procedures and train staff on payer, reimbursement, and regulatory changes.
Promote accountability, accuracy, customer service, and collaboration within Patient Financial Services and across departments.
Ensure billing, collection, and resident account activities comply with CMS, Medicare, Medi-Cal, HIPAA, and organizational requirements.
Maintain current knowledge of reimbursement and regulatory changes affecting billing, collections, and revenue cycle operations.
Perform other duties as assigned.