BUSINESS OFFICE MANAGER JOB DESCRIPTION

State survey readiness cycles and Medicare/Medicaid billing compliance windows set the operational tempo for senior living and skilled nursing communities. When billing workflows fall behind, resident account balances age, payer reimbursements stall, and the administrative foundation supporting resident care erodes. The Business Office Manager owns this entire operational layer - billing, accounts receivable, resident trust funds, payroll, and front-desk staffing - within a single care community. Federal and state regulations governing long-term care finance, including Medicaid pending conversion timelines and I-9 and licensure documentation requirements, define the compliance landscape this role navigates daily.

The mandate of the Business Office Manager is to maintain accurate, compliant billing and administrative operations across all payer types - Medicare, Medicaid, insurance, and private pay - while ensuring the community's HR and payroll functions meet regulatory and organizational standards. The position reports to the Executive Director or community operational leader, with functional coordination extending to corporate billing and human resources teams.

Career Impact: Gaining direct ownership of Medicare and Medicaid billing cycles, resident trust accounting, and state-required HR documentation builds specialized expertise that is consistently sought across SNF, assisted living, and hospice operators.

Business Impact: Accurate AR management and timely payer billing directly determine cash flow for the care community, and errors in resident trust accounting carry regulatory consequences that fall on this role to prevent.

Growth Opportunity: The scope of this position -  spanning finance, compliance, and people management - creates a defined path toward Regional Business Office Director or community Executive Director roles within multi-site long-term care organizations.

• Oversee all accounts receivable functions across Medicare, Medicaid, insurance, and private-pay accounts to ensure accurate balances and timely collections.
• Manage the resident trust fund accounting system, including monthly reconciliation, interest allocation, and security of patient funds.
• Process accounts payable, including invoice review, timely submission to corporate, and budget tracking for the administrative department.
• Coordinate the Medicaid pending application and conversion process to resolve payer transitions within required timelines.
• Administer payroll functions, including timesheet verification, processing, and tracking of PTO and leave balances for community staff.
• Supervise, hire, train, and evaluate business office and front-desk staff to maintain adequate coverage and operational continuity.
• Maintain personnel and compliance files, including I-9 documentation, professional licensure records, workers' compensation filings, and FMLA tracking.
• Prepare and submit month-end billing close and provide AR status reports to the Executive Director and corporate office.

• Associate's degree in business, accounting, or a related field, or equivalent work experience.
• 2 or more years of business office experience in a healthcare or long-term care setting, with direct exposure to billing and collections.
• Working knowledge of Medicare and Medicaid billing rules, payer structures, and reimbursement processes.
• Demonstrated ability to manage accounts receivable, accounts payable, and resident trust fund accounting.
• Experience coordinating payroll processing and maintaining accurate employee records in compliance with HR and regulatory requirements.
• Proficiency in spreadsheet and word processing applications to support financial tracking, reporting, and correspondence.
• Strong organizational skills and the ability to manage concurrent deadlines across billing, HR, and administrative functions.
• Ability to handle confidential resident and employee information with discretion and in accordance with applicable regulations.

• Prior supervisory or lead experience in a skilled nursing facility, assisted living, or hospice business office setting.
• Familiarity with long-term care billing platforms or electronic medical record systems used in a care center environment.
• Experience managing Medicaid pending applications and coordinating with state agencies on conversion timelines.
• Knowledge of OSHA recordkeeping requirements and workers' compensation claim administration in a healthcare facility context.

• Accounts receivable aging, measured by percentage of balances beyond 90 days across all payer types.
• Medicaid conversion cycle time, tracking days from pending application to active billing resolution.
• Payroll processing accuracy rate, reflecting the frequency of corrections or adjustments required after submission.
• Resident trust fund reconciliation variance, measured monthly against posted transactions and interest allocations.
• Business office staffing coverage rate, tracking unplanned gaps in front-desk and billing positions relative to scheduled hours.
• Typical tools: long-term care billing platforms (commonly PointClickCare or MatrixCare); payroll and HRIS systems (commonly ADP or Paylocity).

• Base Salary Range: $50,000 to $70,000 annually, depending on facility size and market
• Bonus: Annual performance bonus, typically 5% to 10% of base salary
• Equity: Not standard for this role in most long-term care organizations
• Health Benefits: Medical, dental, and vision coverage; employer contribution varies by operator
• PTO: 15 to 20 days annually, plus paid holidays
• Common Perks: Continuing education reimbursement, employee assistance program, shift flexibility

Figures are estimates based on general US market benchmarks and may be outdated. Adjust based on location, company size, and seniority level.

Background screening and verification of employment eligibility, including confirmation of authorization to work in the United States, are required conditions of employment for this position. Qualified applicants will be considered without regard to race, color, religion, sex, national origin, age, disability, genetic information, or any other characteristic protected under applicable federal, state, or local law. Reasonable accommodations will be provided to individuals with disabilities throughout the application and employment process upon request.

The Business Office Manager leads all billing, collections, and resident trust accounting operations for a skilled nursing care center, overseeing staff including the Receptionist, Business Office Coordinator, and Assistant BOM. Reporting to the Regional Directors of Business Office Services and the Central Billing Office, this role delivers accurate account management across Medicare, Medicaid, insurance, and private payers to ensure financial integrity and regulatory compliance.

Key Responsibilities

• Lead and coordinate all aspects of the business office, including billing, collections, and resident trust accounting.
• Supervise, hire, and train business office staff.
• Ensure adequate staffing coverage across all business office functions.
• Oversee all aspects of the resident trust accounting system, including the security of patient funds.
• Manage the patient billing system to ensure accuracy of account billing information and coordinate with other departments as necessary.
• Manage all patient-related accounts receivable balances, including Medicare, Medicaid, insurance, private, and other payers, to ensure accurate balances and timely billing and collections.
• Perform front-end and back-end collections of accounts receivable balances due from residents.
• Manage the Medicaid pending application and conversion process to ensure timely resolution.
• Perform month-end closing of the billing system in accordance with policy and timelines.
• Process charges, adjustments, refunds, payment posting, and write-offs promptly.
• Ensure patient bills and collection letters are processed accurately and on time.
• Provide the central billing office with additional billing information to clear claim edits and rejections.
• Coordinate responses to audit requests and attend meetings as needed.
• Comply with all safety policies and practices, and report unsafe activities to the appropriate supervisor.

Education & Experience

• Bachelor's degree from a four-year college or university, or equivalent combination of education and experience.
• Minimum of one year of experience in a skilled nursing facility business office setting, with specific experience in billing, collections, and patient trust accounting.
• Prior supervisory experience in a business office setting preferred.
• Point Click Care billing system experience preferred.
• National Data Care Resident Funds Management System experience preferred.
• Proficient in Microsoft Excel, PowerPoint, and Word.
• Proficient personal computer skills, including electronic mail, record keeping, routine database activity, word processing, and spreadsheet applications.
• Ability to read, analyze, and interpret complex documents.
• Ability to respond effectively to sensitive inquiries and complaints.
• Ability to make effective and persuasive presentations to senior management and public groups.
• Ability to apply mathematical concepts such as fractions, percentages, ratios, and proportions to practical situations.

Embedded within a hospice program's operations team, the Business Office Manager oversees billing for reimbursement, payroll processing, and administrative quality improvement in accordance with hospice policy and federal and state regulatory requirements. Working closely with long-term care facilities, department directors, and the corporate recruiter, this role builds organizational readiness by maintaining accurate financial records, personnel compliance, and performance improvement documentation.

Core Functions

• Maintain updated financial records, including accounts payable, deposits, and contributions.
• Coordinate documentation of contributions and memorials with the relevant foundation.
• Ensure invoices are approved by the appropriate director before submission to accounts payable, and that invoices are sent promptly to take advantage of discounts and avoid late charges.
• Serve as liaison with long-term care facilities' billing departments.
• Maintain records and ensure accuracy of billing for pharmacy, medical supplies, and other items as directed.
• Order office supplies, forms, collateral materials, and medical supplies and equipment as directed.
• Ensure new colleagues complete all required onboarding processes, including orientation, payroll setup, personnel file creation, system access, and identification badge photo.
• Create and maintain confidential personnel records, including candidate information sheets and employment applications, and follow records retention policy for terminated files.
• Track and ensure timely updates to colleagues' professional licenses, automobile insurance, in-service training, contract renewals, and physician licenses.
• Initiate personnel requisitions, provide application and background release forms to the recruiter, and communicate candidate status to the hiring supervisor.
• Monitor and report on quality indicators, maintain documentation, gather data, and generate reports related to performance improvement projects.
• Monitor and maintain the master calendar of activities required by regulatory agencies and assist in maintaining readiness for regulatory review.
• Handle general office maintenance, serve as the resource for troubleshooting office equipment, and maintain inventory records on equipment.

Required Qualifications

• High school diploma or general education degree, or equivalent combination of education and experience.
• Experience in insurance and Medicare/Medicaid billing and reimbursement preferred.
• Experience in office management helpful.
• Ability to perform mathematical calculations, including addition, subtraction, multiplication, division, and computation of rate, ratio, and percentage.
• Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, and governmental regulations.
• Ability to write reports, business correspondence, and procedure manuals.
• Ability to effectively present information and respond to questions from leaders, colleagues, investors, and external parties.
• Demonstrated leadership skills with the ability to move into a people management position in a relatively short period of time, if needed.
• Ability to handle stressful situations and multi-task in a fast-paced environment.

Reporting to the executive director and corporate office, the Business Office Manager administers all community accounting systems and human resource functions, including accounts receivable, payroll, resident billing, and front desk operations, in accordance with federal, state, and local standards. Partnering with department heads, legal, and the corporate office, this role shapes the financial and operational foundation of a senior living community by ensuring confidentiality, compliance, and staff development.

Primary Duties

• Perform, administer, and oversee all community accounting functions, including accounts receivable, accounts payable, and management reports.
• Prepare and send resident billing statements, track daily census, make bank deposits, process daily changes per updated addenda, and process refunds or credits.
• Ensure accounts are up to date, outside vendors are paid promptly, and all accounts payable and receivable activities are current.
• Facilitate collections and coordinate resident move-in, move-out, and transfer documentation.
• Work with the corporate office to ensure all aspects of resident billing, payment, rent, rent increases, and related charges are submitted on time and per standards.
• Coordinate all payroll functions, including posting job openings, coordinating interviews, conducting background and reference checks, confirming hours worked with supervisors, transmitting payroll information for processing, and tracking and reporting labor variances.
• Manage employee benefit programs, including communicating plan details and eligibility requirements to employees, ensuring timely enrollments and terminations, and confirming that employee deductions are correctly applied.
• Maintain all aspects of employee files, including base wages, tax withholding, wage rates, and annual or merit increases.
• Maintain and update all resident, personal, and insurance files.
• Manage, plan, develop, organize, schedule, evaluate, and direct the front desk department in accordance with all policies and procedures, including hiring, training, and supervising front desk team members.

Qualifications & Experience

• High school diploma or GED.
• Background clearances as required by government regulations are mandatory.
• Negative TB test results within the last six months or within seven days of employment are mandatory.
• Associate's degree or several years of college coursework preferred.
• Bachelor's degree highly desirable.
• Fundamental accounting experience or knowledge preferred.
• Fundamental human resources experience or knowledge preferred.
• Prior supervisory or lead experience preferred.
• Proficient in Microsoft Word, Excel, Outlook, and email, and familiar with standard office equipment such as scanners, copiers, and fax machines.
• Ability to perform mathematical calculations in support of financial responsibilities, budgeting, and personnel actions.
• Ability to maintain strict confidentiality of data and information.
• Excellent oral and written communication skills in English, including the ability to explain and present information clearly to audiences at varying levels of understanding.
• Ability to make independent decisions when circumstances warrant and to remain calm during stressful situations or emergencies.
• Ability to deal tactfully and professionally with personnel, residents, family members, and guests at all times.

Sitting at the intersection of financial management and strategic portfolio planning, the Business Office Manager reports to the Citi Realty Services Business Office APAC Lead and owns the financial plan for the real estate services unit, with a primary focus on managing the APAC divestiture program and new strategic initiatives. Operating across regional functions, including technology, security, shared services, and finance, this role delivers executive presentations, portfolio optimization plans, and divestiture reporting to drive measurable savings and business continuity across all affected countries.

Accountabilities

• Manage and deliver the financial plan for the real estate services unit.
• Collate data from all countries and functions and deliver monthly operating reports along with various metrics, including portfolio and people data.
• Coordinate across functions to support more effective governance of business operations.
• Work with senior management on strategic planning, portfolio optimization plans, and city plans, and provide financial and strategic inputs to optimize the portfolio and drive savings.
• Develop executive presentations, project reports, and dashboards articulating key drivers and economics of proposals.
• Ensure compliance with policies, procedures, and legal, regulatory, safety, and environmental requirements to maximize portfolio value.
• Partner and coordinate with internal stakeholders, including asset, transaction, project, and finance managers, to support implementation of strategic portfolio rationalization.
• Track project updates, actual investment spend, and productivity savings.
• Provide financial inputs on various real estate initiatives and strategies to the financial planning and analysis team during planning and budgeting cycles.
• Support the divestiture program by managing and reporting on the segregation strategy, ensuring consistency of strategies and reporting across countries, and ensuring timely legal-day-one separation and business continuation in all affected countries.
• Administer ground execution of closures, consolidations, relocations, and exits of retail, including management and tracking of the overall divestiture budget.
• Coordinate across regional functions, including technology, security, shared services, and continuity of business, on divestiture execution.
• Coordinate with the finance team on divestiture-related investment evaluation proposals and lease renewal processes, and develop and manage processes for dashboard reporting, executive summaries, and progress monitoring.
• Formulate trackers, analyze data for trend and status reporting, and provide ad hoc reports to local and regional management.

Skills & Qualifications

• Recognized degree in facilities management, project management, engineering, architectural or interior design, real estate, or financial management.
• Experience using Microsoft Office software in a business problem-solving context.
• More than ten years of professional experience in real estate or a similar corporate real estate environment.
• Experience in financial management and budget control.
• Strong analytical skills with experience in quantitative analysis and data-driven problem-solving.
• Strong relationship management skills with experience in an international corporate environment.
• Strategic planning and quality service management experience.
• Process review and implementation experience.
• Strong organizational and time management skills with the ability to work in a fast-paced environment.
• Ability to manage and communicate multiple projects simultaneously.
• Excellent vendor management skills within a partnering environment.
• Excellent communication skills with fluency in English.

A key member of the care center's operations and management team, the Business Office Manager assists the Executive Director with day-to-day accounting functions, including accounts receivable, payroll, and resident fund management in a long-term care setting. Collaborating across departments and reporting directly to the Executive Director, this role owns the financial accuracy and administrative compliance that supports resident care and regulatory adherence.

Duties

• Comply with personnel, safety, and corporate policies and procedures.
• Report witnessed or alleged incidents of resident abuse or neglect immediately to the appropriate manager.
• Treat residents, family members, visitors, and team members with respect and dignity, and maintain the confidentiality of all resident and family information.
• Perform eligibility verification, complete admission financial paperwork, and attend daily admission and weekly department head meetings.
• Perform daily upkeep of the accounts receivable system, including census, cash, ancillaries, adjustments, and dashboard review.
• Process accounts payable on a daily basis and ensure timely delivery to the corporate office.
• Process payroll, maintain accurate records of employee time-off hours, and create and maintain all employee files.
• Process workers' compensation paperwork, track FMLA absences, and maintain administrative files, including resident billing files, OSHA log, workers' compensation files, and Medicare and Medicaid files.
• Maintain the resident fund account, including monthly balancing, interest allocation, and quarterly statement distribution.

Requirements

• High school diploma or equivalent.
• Basic computer skills required.
• Ability to read, write, speak, and understand English.
• Ability to work beyond normal hours and on weekends and holidays when necessary.
• Ability to perform physical tasks, including bending, stooping, kneeling, crouching, and overhead lifting.
• Ability to relate to and work with ill, disabled, elderly, and emotionally upset individuals within the community.

Efficient care center operations depend on the Business Office Manager, who oversees the business office's day-to-day administrative functions, including staffing, payroll review, billing oversight, and front desk management, across a senior living or long-term care community. Based within the care center's management structure and reporting to the operational leader, this role delivers staff performance development, budget accountability, and workflow improvements that support both resident experience and organizational efficiency.

Role Responsibilities

• Oversee the day-to-day operations of the business office, including staffing coverage and management.
• Organize office operations and procedures, including correspondence flow, filing, and other operational duties, and evaluate office production to revise procedures and improve workflow efficiency.
• Process orders for all necessary equipment and supplies within budgetary guidelines and maintain inventory control.
• Account for the administrative budget and provide reports to management as requested.
• Promote the personal and professional growth of staff, conduct performance reviews, and manage hiring decisions and disciplinary situations for open positions.
• Review weekly payroll reports, address payroll concerns, and work with corporate payroll to resolve issues.
• Maintain associate personnel files and complete staff training and orientation as needed.
• Complete or assist with special projects as requested by community or senior management.
• Conduct community tours for prospective residents and their families.
• Review and submit invoices to accounts payable for administration.
• Monitor billing errors and telephone system issues, and contact the provider to resolve issues.

Qualifications & Experience

• Extensive knowledge of a distinct skill or function.
• Thorough understanding of the organization and work environment.
• Working knowledge of a functional discipline and basic accounting terminology and processes.
• Proficient with computer use and software applications.
• Effective written and oral communication skills.
• Ability to speak effectively before groups of customers or associates.
• Excellent organizational skills and multitasking abilities.
• Consistently demonstrates sound judgment in day-to-day operations and interactions with associates and residents.

As the Business Office Manager, this role oversees accounts payable, accounts receivable, resident trust fund management, and employee health program coordination within a healthcare facility. The finance and administrative team relies on this work to ensure accurate census and statistical reporting, regulatory compliance, and timely collections that support the facility's overall fiscal performance.

Job Functions

• Process accounts payable, accounts receivable, adjustments, private and third-party agency transactions, and census information.
• Manage resident trust funds and maintain confidential files.
• Manage collections of past-due resident accounts receivable and provide reports to the administrator and corporate headquarters.
• Coordinate all facility fiscal processes with the corporate office.
• Accumulate, maintain, and compile statistical information as directed.
• Conduct new employee orientation and coordinate competency completion.
• Ensure delivery of annual mandatory and continuing education for staff using internal or external resources, in accordance with applicable regulations and policy.
• Coordinate the employee health program, including immunizations, flu shots, and physical exams.
• Maintain employee education, training, and health files.
• Complete required forms and documents in accordance with policy and applicable regulations.

Experience & Qualifications

• Minimum of two years of financial experience in a healthcare setting.
• Experience in a supervisory capacity.
• Working knowledge of current insurance procedures and contracts.
• Proficient in computer accounting and health information systems, as well as Microsoft Excel, Outlook, and Word.
• Knowledge of laws, regulations, and guidelines about the healthcare financial process.
• Experience demonstrating problem-solving and independent decision-making capabilities, along with the skills to plan, organize, develop, interpret, and implement business office programs and procedures.
• Demonstrated ability to interact positively and effectively with residents, their families, service providers, and colleagues.

Business Office Manager supports the Executive Director across payroll, hiring, human resources, billing, and collections functions within an assisted living community operating under Calyx standards. Success in the position means maintaining accurate personnel files, managing resident inquiries and tours, and enabling recruitment activities that sustain resident care delivery for the senior population.

What You'll Do

• Support the executive director in the management of payroll, hiring, human resources policies and practices, billing, and collections, as well as general administrative functions.
• Maintain personnel files in accordance with applicable policies and regulations.
• Answer, screen, and route phone calls and visitors per applicable policies, and document and forward concerns from callers to the appropriate director.
• Support marketing efforts by taking leads from potential interested individuals and assisting with tours.
• Support resident care through recruitment and hiring activities.

Background & Experience

• High school degree plus two years of business school or college, including accounting and bookkeeping courses.
• Minimum of three years' experience as an administrative assistant or general office staff member, with basic accounting knowledge.
• Proficient in Microsoft Word and Excel.
• Working knowledge of accounting and payroll software preferred.
• Previous experience in accounts payable and payroll a plus.
• Good telephone and interpersonal communication skills.
• Ability to manage responsibilities while handling phone and in-person visitors.
• Demonstrated interest in working with the senior population.

The Business Office Manager produces a counterparty credit risk platform and risk management framework for equity derivatives, overseeing stress models, credit assessment, and risk reporting in coordination with sales, trading, and second-line partners. Reporting to the Administrator and interfacing with the Regional Business Office Coordinator, Assistant Office Manager, and corporate stakeholders, this role advances pre-trade and post-trade risk monitoring to protect the organization's regulatory capital position and governance standards.

Key Deliverables

• Develop and maintain a counterparty credit risk platform and risk management framework for equity derivatives.
• Build and improve tools to measure counterparty risk on a pre-trade and post-trade basis.
• Ensure appropriate risk monitoring and oversight, including stress models, credit assessment, risk reporting, and escalation governance.
• Engage with second-line partners on bespoke or complex derivative transactions to ensure accurate reflection of trade-specific risk.
• Liaise and coordinate with sales and trading on new products, including limits and stress testing, and provide subject matter expertise support on risk-related activities.
• Monitor client portfolios to ensure risks are controlled and perform standard and customized risk analysis.
• Prepare presentations and documents on stress methodologies, risk governance, and key risk issues for internal and external use.
• Analyze the control environment, including periodic review of key controls and vetting of new systems, processes, and policies.
• Coordinate with the financial resource management team to ensure connectivity to regulatory capital requirements.

Professional Experience

• Experience managing market or credit risk.
• Experience across equities and/or structured products.
• Strong analytical skills with demonstrated aptitude for quantitative modeling and data analysis.
• Clear and concise written and verbal communication skills.
• Ability to work independently and collaboratively with multiple functional groups.
• Ability to multi-task and prioritize initiatives effectively.

Embedded within a care center's operations and management team, the Business Office Manager reports to the operational leader and oversees administrative functions spanning billing, payroll, medical records, human resources, and staffing compliance across non-clinical departments. Developing non-clinical and administrative staff while maintaining compliance with regulatory documentation requirements, this role produces the operational infrastructure that enables safe, well-supported patient care delivery.

Key Responsibilities

• Coordinate systems and procedures across medical records, data entry, claims review, and personnel and human resource functions to ensure efficient and compliant billing and payroll operations.
• Ensure continuous coverage in all administrative areas through appropriate staffing assignments and workload distribution, and supervise non-clinical staff.
• Ensure appropriate orientation for all new staff.
• Screen, interview, and make appropriate hiring decisions for non-clinical and administrative staff.
• Conduct performance appraisals and reviews in compliance with policy and procedures.
• Maintain compliance with all required employee documentation for human resources and regulatory agencies, including I-9 compliance, professional licensure, and background checks.
• Maintain an ongoing evaluation of space, supplies, and equipment needs for the care center.
• Communicate with the IT department regarding system problems, repairs, and troubleshooting as needed.

Qualifications & Experience

• High school diploma required.
• Bachelor's degree in business or a related field preferred.
• Minimum of two years of office or related experience required.
• Minimum of two years of office or related experience in a healthcare environment preferred.
• Supervisory or management experience in a healthcare setting preferred.
• Medical billing and financial management experience preferred.
• Strong computer and software skills.
• Valid driver's license and automobile insurance coverage required.