Job Description
Business Office Manager / Human Resources Position Summary The Business Office Manager / Human Resources is responsible for overseeing the daily operations of the business office with a strong emphasis on billing, claims management, accounts receivable, payroll administration, human resources, and regulatory compliance. This role ensures accurate financial processing, timely claims follow-up, employee record management, and efficient administrative operations within the community. The ideal candidate is highly organized, detail-oriented, and experienced in MassHealth Adult Foster Care (AFC), Group Adult Foster Care (GAFC), Adult Day Health and healthcare administration, or business office operations. The candidate must demonstrate strong analytical and communication skills while maintaining confidentiality and professionalism in interactions with members, families, caregivers, employees, vendors, and leadership. Duties and Responsibilities Business Office, Billing & Claims Operations Oversee daily business office operations, administrative functions, and financial processes. Maintain accurate billing records, invoices, payment documentation, and financial files. Manage insurance billing, claims processing, payment posting, collections, and accounts receivable activities for MassHealth, Tufts Health Plan, United Healthcare, Commonwealth Care Alliance, Molina (Senior Whole Health, Fallon Health, Mass General Brigham Health Plan and Pace Program. Monitor outstanding balances and conduct timely follow-up on unpaid claims, delinquent accounts, and collection matters. Supervise administrative staff to ensure efficient office operations. Utilize EMR/EHR systems including Inovalon, PlaySpan, MyAbility, Availity, Allscripts, Epic, and similar healthcare platforms. Ensure compliance with healthcare regulations, including HIPAA, CARF International standards, and managed care requirements. Familiar with Senior Care Options and OneCare Collaborate with nursing, case management, and medical management teams to support workflow efficiency and service delivery. Oversee office management functions, including supply procurement, equipment maintenance, and facility safety protocols. Develop and implement policies and procedures related to medical administrative support, billing operations, utilization management, and medical records management. Process accounts payable, reconcile invoices, and coordinate vendor payments. Assist with budgeting, expense management, financial reporting, audit preparation, and overall financial oversight. Ensure billing accuracy and compliance with company policies, accounting standards, and regulatory requirements. Respond to billing inquiries and coordinate payment resolutions with members, families, insurance providers, and external agencies. Maintain strict confidentiality of all financial, payroll, billing, and member information. Payroll & Human Resources Administration Process payroll accurately and timely, including verification of caregiver logs, timesheets, payroll adjustments, and payroll record maintenance. Maintain employee personnel files and compliance documentation, including: Background checks CORI and SORI screenings OIG verification I-9 documentation Nursing registry verification Home Health Aide and Licensed Nurse credentials HR compliance records Coordinate recruitment, hiring, orientation, onboarding, and employee offboarding processes. Assist with employee relations, benefits administration, workers’ compensation claims, unemployment documentation, and FMLA administration. Ensure compliance with federal and state labor laws, wage and hour regulations, and company HR policies. Support department managers with employee documentation, corrective actions, scheduling coordination, and HR-related matters. Monitor employee certifications, required trainings, and compliance deadlines. Compliance & Administrative Support Maintain compliance with state regulations, labor laws, healthcare standards, and company policies. Prepare reports and documentation for audits, inspections, payroll reviews, and financial reconciliations. Maintain organized filing systems and confidential administrative records. Communicate professionally and effectively with employees, members, families, vendors, and external agencies. Foster a positive, professional, and service-oriented office environment. Qualifications Bachelor’s degree in Business Administration, Accounting, Human Resources, Healthca