Business Office Manager

Ridgeway Rehabilitation & Senior Living -

JOB   SUMMARY :

The   primary   purpose   of   the   Business   Office   Manager   position   is   to   evaluate   and   monitor   the   financial   viability   of   all   referrals   to   Arabella   facilities,   communicate   financial   and   benefits   information   to   residents   and / or   family   members,   collect   patient   liabilities,   copays,   and   other   private   pay   charges   upon   admission   and   on   an   ongoing   basis,   monitor   the   application   and   approval   status   of   all   Medicaid   Pending   residents,   administer   the   resident   trust,   maintain   and   report   resident   demographic,   financial,   and   census   data,   assist   the   Centralized   Billing   Office   with   charge   capture   activities   for   ancillary   and   other   charges. Medicare,Medicaid,Va, Medicare Replacement plans and all managed care insurances experience is a requirement for this position.

JOB   DUTIES   &   RESPONSIBILITIES :

Resident   Financial   Functions

• Receive,   review,   and   evaluate   all   referrals   for   potential   admission   to   a   Arabella   facility,   to   determine   financial   eligibility   and   viability.
• Review   the   common   working   file   for   Medicare-funded   referrals   to   determine   Medicare   eligibility.
• Communicate   financial   viability   to   the   Admissions   Coordinator   and   discuss   medications,   equipment,   and   other   special   needs   that   impact  the  cost   of   care.
• Prepare   a   cost   projection   for   all   financially   viable   referrals   to   Arabella   facilities,   based   on  the  determination   of   clinical   and   other   needs   (as   identified   by   the   Admissions   Coordinator).  Determine   Medicare   Part   B   coverage   prior   to   the   initiation   of   therapy   services   by   the   therapy   vendor.
• For   all   referrals   who   will   convert   to   Medicaid   during  the  length   of   stay,   determine   whether   or   not   the   Medicaid   application   process   has   been   initiated;   Work   with   the   referral   source   and   family   to   initiate   the   process   if   not   yet   begun.   Review   the   state’s   home   page   to   determine   whether   or   not   the   referral   currently   has   property   or   has   recently   transferred   assets   which   would   prevent   Medicaid   eligibility.   Initiate   Medicaid-pending   tracking   log.
• Ensure   the   timely   submission   of   all   required   assessments   and   documentation   related   to   Medicaid   eligibility   (PAE,   PASARR,   DMAS,   FL-2,   etc.) .   Ensure   that   these   forms   are   updated   and   resubmitted   as   necessary.
• Determine   the   need   for   and   obtain   pre-authorization   for   managed   care   payers   including   those   for   primary,   secondary,   and   ancillary   services.  Ensure   that   required   ongoing   authorizations   are   obtained   by   facility   clinical   staff.
• Collect   all   upfront   monies   due   upon   admission.
• Ensure   the   collection   of   all   private   pay   balances   as   they   become   due   and   payable.
• Ensure   that   resident   admission   contracts   are   signed   and   appropriately   filed.
• Ensure   appropriate   supporting   documents   are   scanned   into   the   electronic   medical   record   (consent   to   treat,   common   working   file   (CWF),   copies   of   insurance   cards,   etc.)  Verifies   and   records   specific   ancillary   charge