Business Office Manager

Department: Administration

Reports To: Executive Director

 Job Summary

The Business Office Manager is responsible for overseeing the financial operations and plan management activities of the PACE Your LIFE Program. This position plays a key role in ensuring accurate claims adjudication and payments in coordination with the contracted Third-Party Administrator (TPA), as well as overseeing Medicare Part D submissions through the Pharmacy Benefit Manager (PBM). The Business Office Manager partners closely with the program's accountant and Executive Director on budgeting, financial reporting, and provider contract administration. Additionally, this role fosters and maintains strong provider relationships and ensures all necessary documentation is obtained and maintained.

 Essential Duties and Responsibilities

·         Process accounts payable and vendor invoices accurately and in a timely manner using the designated financial systems.

·         Coordinate adjudication and payment of medical and utilization claims through the contracted TPA.

·         Ensure proper contract filing, authorization tracking, and oversight of Incurred But Not Reported (IBNR) claim management.

·         Monitor risk-based capitation arrangements and support the preparation of the annual Medicare Part D Bid.

·         Manage revenue processes and accounts receivable, ensuring timely resolution of enrollment and disenrollment issues.

·         Collaborate with the PBM on all Part D functions, including Prescription Drug Event (PDE) submissions, reporting, and system monitoring.

·         Support audit and monitoring efforts related to the Part D Fraud, Waste, and Abuse Compliance Program.

·         Assist in the development of the annual operating and capital budgets in collaboration with the Program Director and accountant.

·         Assist in the preparation and analysis of monthly financial statements and statistical reports.

·         Ensure timely and accurate submission of required financial reports to CMS and state agencies.

·         Serve as a financial consultant to the PACE program, providing relevant analysis and recommendations.

·         Present financial data to department managers and staff, ensuring a consistent budget variance reporting and follow-up process.

·         Keep the Executive Director informed of financial concerns, risks, or anomalies.

·         Support Medicare risk adjustment data submissions, as needed.

·         Participate in internal committees such as Utilization Management and Pharmacy.

·         Maintain professionalism and confidentiality in all duties.

 General Expectations

·         Maintain availability during business hours to support staff, vendors, and program partners.

·         Meet all performance, punctuality, and attendance expectations.

·         Foster respectful and professional relationships across all levels of the organization and with external stakeholders.

·         Demonstrate adaptability in response to changing business needs or priorities.

·         Accept and perform additional duties outside the routine scope, as needed.

 Qualifications

Education

·         Bachelor’s degree in Accounting, Finance, or a related field required.

 Experience

·         Minimum 2–4 years of experience in business office management within a healthcare environment.

·         Experience with Medicare Part D and TPA/PBM coordination strongly preferred.

 Licensure/Certification

·         None required.

 Patient Population

·         Adult and geriatric population.

 Knowledge, Skills, and Abilities

·         Proficiency in Microsoft Office Suite, particularly Excel and Word.

·         Familiarity with claims processing systems and healthcare financial systems.

·         Strong understanding of financial reporting, budgeting, and analysis principles.

·         Exceptional organizational skills and attention to detail.

·         Ability to maintain confidentiality of sensitive information.

·         Strong interpersonal skills, including the ability to communicate effectively in writing and verbally.

·         Ability to prioritize tasks and meet deadlines in a dynamic environment.

·         Demonstrated integrity and professional conduct.

·         Knowledge of emergency protocols and safety practices within a healthcare facility.

·         Ability to navigate the facility safely and assist in emergency situations as needed.

 Conditions of Employment

·         Must be free from the use or effects of illegal drugs and alcohol in the workplace.

·         Individuals with a record of abuse, neglect, or mistreatment of individuals in a healthcare setting are ineligible for this position.