Job Description

Job Description

Job Description

Description:

Position Summary: The Business Office Manager directs and holds accountable the revenue cycle functions for Kane County Hospital and its clinic operations, including registration, insurance eligibility, procedure and surgery authorizations, charge capture coordination, claim submission, billing, payment posting, cash collections, patient statements, financial counseling coordination, denials management, accounts receivable follow-up, refunds and credit balances, bad debt preparation, payer compliance, staff training, and revenue cycle reporting.

Scope of Responsibility

The Business Office Manager is responsible for hospital, emergency department, outpatient, ancillary, surgical, and clinic business office operations. The position oversees processes that directly affect patient access, payer authorization, billing accuracy, collections, denial prevention, cash flow, compliance, reporting, and patient financial communication.

Essential Responsibilities

1. Direct daily registration operations and ensure complete and accurate patient demographic, guarantor, subscriber, insurance, accident, workers compensation, Medicare Secondary Payer, consent, notice, and financial information before or at the time of service whenever operationally possible.
2. Maintain effective insurance eligibility, benefit verification, medical necessity screening, payer-specific documentation, and pre-service financial clearance processes.
3. Oversee procedure, imaging, infusion, surgery, observation, inpatient, and outpatient service authorization workflows and require documentation of authorization status, reference numbers, payer communications, and escalation steps before services are performed when authorization is required.
4. Coordinate with clinical departments, providers, coding, and Health Information Management to reduce charge lag, missing documentation, late charges, coding-related delays, and claim holds.
5. Ensure clean, accurate, timely claim submission for institutional, professional, clinic, emergency department, outpatient, surgical, ancillary, Medicare, Medicaid, commercial, managed care, workers compensation, and self-pay accounts.
6. Manage denial prevention and denial recovery by tracking denial reasons, assigning accountability, correcting root causes, appealing timely, and reporting trends to leadership.
7. Manage accounts receivable follow-up by payer, aging category, account type, denial status, authorization status, and dollar priority.
8. Oversee patient billing, statements, payment plans, point-of-service collections, financial counseling coordination, charity care and financial assistance routing, bad debt preparation, refunds, and credit balance resolution.
9. Monitor cash collections, payment posting accuracy, contractual adjustments, underpayments, recoupments, payer takebacks, and unapplied cash.
10. Prepare and review required revenue cycle reports, including accounts receivable aging, denial trends, authorization performance, cash collections, point-of-service collections, claim lag, DNFB, credit balances, bad debt, and productivity.
11. Train, supervise, schedule, evaluate, and hold business office staff accountable for accuracy, timeliness, productivity, payer compliance, customer service, confidentiality, and completion of assigned work.
12. Maintain written procedures, payer-specific job aids, checklists, audit files, staff training records, and corrective action documentation for assigned business office functions.
13. Coordinate with the Chief Financial Officer on payer issues, revenue leakage, policy gaps, compliance concerns, staffing needs, system issues, and process improvement priorities.
14. Perform other related duties as assigned by the Chief Financial Office

Knowledge, Skills and Abilities

1. Strong working knowledge of hospital and clinic revenue cycle operations, including registration, eligibility, authorizations, coding interfaces, billing, collections, denials, refunds, and credit balances.
2. Ability to read, interpret, and operationalize payer rules, authorization requirements, remittance advice, explanation of benefits, payer contracts, and billing edits.
3. Knowledge of Medicare, Medicaid, commercial payer, managed care, workers compensation, self-pay, and patient financial assistance workflows.
4. Ability to supervise staff, enforce deadlines, measure productivity, correct errors, and document accountability.
5. Strong analytical skills, including the ability to interpret accounts receivable aging, denial reports, cash reports, credit balance reports, authorization reports, and productivity reports.
6. Ability to communicate clearly with patients, staff, payers, clinical departments, vendors, auditors, and leadership.
7. Commitment to confidentiality, accuracy, compliance, audit readiness, and professional patient financial communication.
8. Ability to work independently within Oracle (Cerner) and SSI.
9. Experience in a rural or critical access hospital.

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