Business Office Director

About the role

Nestled in San Francisco's Excelsior neighborhood on a nine-acre campus, the San Francisco Campus for Jewish Living (SFCJL) is the leading senior services organization in Northern California. Our continuum of care includes: the Frank Residences assisted living and memory care; the Jewish Home and Rehabilitation Center, offering long-term skilled nursing, short-term rehabilitation, an acute geriatric psychiatric unit for adults over the age of 65; and our Foundation.

Founded in 1871 and formerly known as the Jewish Home, our legacy grounds us as our vision propels us forward. Today, we've evolved to support more than 2,500 older adults each year through innovative, comprehensive programs rooted in the Jewish values of compassion, community, and excellence. We are equally proud of our inclusive culture, where 950 team members of diverse faiths and backgrounds work together in shared purpose.

Position Summary

As the Business Office Director, you will oversee day-to-day billing, collections, cash posting, and resident account operations for the San Francisco Campus for Jewish Living (SFCJL). You will lead Patient Financial Services (PFS) staff and ensure claims are submitted accurately and timely, payments are posted correctly, and accounts receivable are actively managed to resolution across all payer types.

This role serves as a key financial resource for residents and families and works closely with Admissions, Case Management, MDS, Accounting, and other departments to ensure complete and accurate billing information, strong revenue cycle performance, and compliance with applicable reimbursement requirements.

Key Responsibilities

Billing & Claims

• Oversee the timely and accurate generation and submission of claims (UB-04/837I) 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 (5) days of the billing cycle.
• Participate in the monthly Triple Check process with Nursing, MDS, and Case Management to confirm charges and supporting documentation are accurate before claims are released.
• Ensure payer-specific billing requirements are followed and work with responsible departments to resolve missing, incomplete, or inconsistent billing information.

Cash Posting & Reconciliation

• Oversee the posting of Electronic Remittance Advice (ERA) and Explanation of Benefits (EOB) payments in PointClickCare (PCC) and ensure payments are applied to the appropriate accounts.
• Identify underpayments, overpayments, and rejected payments and escalate significant payer issues to the Chief Financial Officer.
• Collaborate with Accounting to reconcile cash receipts to bank activity and the general ledger each month.

Denials & Appeals

• 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 Treatment Authorization Request (TAR) denials.
• Monitor and report denials by root cause and identify recurring issues requiring staff education, workflow changes, or process improvements.
• Work toward maintaining a denial rate below 5%.

Accounts Receivable & Collections

• Review accounts receivable aging reports weekly and prioritize collection activity by payer and aging category.
• Ensure appropriate payer follow-up occurs on all outstanding claims older than 30 days.
• Maintain clear biller assignments by payer and regularly review individual portfolios to identify unresolved or aging balances.
• Work toward maintaining days in accounts receivable below 45 days and resolving 98% of collectible balances within 90 days.
• Provide detailed aged accounts receivable and collectability assessments to support bad-debt reserve calculations and year-end audit activities.

Resident & Family Accounts

• Issue monthly private-pay statements and serve as a primary point of contact for residents, families, and responsible parties regarding billing and account questions.
• Establish payment plans and apply the organization's charitable care policy when appropriate.
• Manage the resident trust fund in accordance with applicable federal and state requirements.
• Oversee petty cash and on-site payment collections.

Eligibility & Admissions Support

• Partner with Admissions to verify insurance eligibility and coverage at admission and monthly using payer portals and eligibility tools, including Availity.
• Confirm authorizations, payer information, financial classifications, and billing types are accurately established in PointClickCare.

Reporting & Revenue Cycle Operations

• Prepare monthly business office reports for the Chief Financial Officer, including collections, accounts receivable aging, denials, payer mix, and days in accounts receivable.
• Serve as the Patient Financial Services representative on the Revenue Cycle Team.
• Support PointClickCare optimization initiatives, including workflow improvements and staff training.

Staff Leadership & Development

• Supervise, schedule, train, and develop billing and collections staff.
• Establish work procedures and hold staff accountable for established performance goals.
• Maintain current business office procedures and ensure staff receive appropriate training regarding payer, reimbursement, and regulatory changes.
• Promote accountability, accuracy, customer service, and effective collaboration within Patient Financial Services and across departments.

Compliance

• Ensure billing, collection, and resident account activities comply with applicable 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.

Job Details

• Pay Rate: $159,361 - $176,135 annually
• Hours: Full-Time, Exempt
• Shift Schedule: Business Hours | Monday - Friday
• Days Off: Saturday & Sunday
• Working Days: Monday through Friday

Required Qualifications

• Associate degree in Business, Accounting, Healthcare Administration, or a related field, or equivalent relevant work experience.
• Minimum of three (3) years of healthcare billing and collections experience, including at least two (2) years of experience 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 with the ability to effectively communicate 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.

Preferred Qualifications

• 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).

Physical Requirements

• Ability to sit and work at a computer for extended periods.
• Ability to stand and move throughout office and campus environments as needed.
• Ability to perform repetitive keyboarding and other fine motor activities associated with computer-based work.
• Ability to communicate effectively in person, electronically, and by telephone.
• Good visual and auditory acuity to perform the essential functions of the position.

Pay and benefits

Comprehensive benefits, including Medical, Dental, and Vision coverage; a 403(b) Retirement Plan; Paid Time Off (PTO); Tuition Reimbursement; Commuter Benefits; and Weekday Shuttle Service to and from Glen Park BART Station.