A home health bookkeeper keeps the agency's books for both service lines. They post deposits from Medicare, Medicaid, insurers and private-pay families, pay vendors and mileage for nurses, therapists and caregivers, reconcile every account, and prepare the entries the CFO needs to close each month.
By the HireBus team · Updated · Pay data: BLS, May 2025
Median pay, home health care agencies · BLS, May 2025
We're hiring a Bookkeeper to keep the agency's books accurate. You'll pay vendors, record deposits from Medicare, Medicaid, insurers, and private-pay families, reconcile accounts, process mileage reimbursements, and help the CFO close each month. Claims belong to the Billing Specialist; you handle what runs through the general ledger.
2. Essential Duties and Responsibilities
Pay vendors for medical supplies, software, rent, and other costs on schedule.
Record deposits and match them to remittances and private-pay invoices.
Reconcile bank, credit card, and payroll accounts every month.
Process mileage and expense reimbursements for clinicians and caregivers under [your mileage policy].
Prepare journal entries, accruals, and supporting schedules for month-end close.
Support the CFO and outside accountants with audits, tax filings, and the Medicare cost report.
3. Key Tasks / Daily Activities
Enter and code vendor bills, and route them for approval.
Record the day's deposits and electronic payments.
Review mileage submissions for missing logs or duplicates.
Answer vendor and staff questions about payments.
4. Key Performance Indicators (KPIs)
Month-end close on schedule: [your target].
Reconciliations completed on time: [your target].
Mileage reimbursement errors: [your target].
Vendor payments made on time: [your target].
5. Required Qualifications and Skills
High school diploma or equivalent; accounting coursework is a plus.
[2+] years of bookkeeping or accounting experience.
Comfortable with [QuickBooks or your accounting software] and spreadsheets.
Catches small errors before they reach the financial statements.
Keeps financial and employee information confidential.
6. Preferred Experience
Bookkeeping experience at a health care or home care company.
Associate degree in accounting.
Experience with payroll for an hourly workforce that works in the field.
7. Physical Requirements
Sitting at a computer for long periods.
Occasionally lifting files and supplies up to [15] pounds.
With or without reasonable accommodation.
8. Work Environment and Schedule
Office-based in [office city]; hybrid work: [your policy].
Regular hours: [Monday through Friday], with longer days at month-end.
Works closely with the Billing Specialist and payroll on deposits and reimbursements.
9. Compensation and Benefits
Pay: [range and hourly or salary basis].
Additional pay: [overtime, bonus or incentive terms, or none].
Benefits: [health, dental, vision, retirement, paid time off, and when they start].
10. Company Culture and Overview
[Two or three sentences on what your company does, the area you serve, and the support a new bookkeeper gets in the first 90 days.]
11. How to Apply
[Apply link or email]. Our process: [phone interview, in-person interview, and next steps]. Contact [hiring contact] if you need an accommodation during the application process.
Need help filling this role? HireBus posts the ad, Iris interviews every applicant by phone before you do, and you decide who to hire. Start hiring now
The home health ledger has three things most small-business books don't: a field staff repaid for every mile, Medicare money that can be taken back, and patient names on the deposit records.
Mileage logs decide the tax answer
Nurses, therapists and caregivers spend the day driving between patients, often in their own cars. Under IRS rules, mileage repaid through an accountable plan stays out of taxable wages only if each trip is for work, the worker accounts for it within a reasonable time, and any extra is returned. Repayments that miss those rules go on the W-2 as wages. The bookkeeper checks each log for dates, places and miles before paying it. Source: IRS Publication 463: Travel, gift, and car expenses.
Car costs count in the minimum wage check
Federal rules say wages must be paid free and clear, so a cost the job puts on a worker can't cut pay below the minimum or the overtime owed. Labor Department investigators may value a worker's own car at the IRS business mileage rate. For an hourly caregiver paid near the minimum, a low mileage rate can push a week under the line. Federal coverage of agency caregivers may change: a July 2025 DOL proposal isn't final, and a state's own wage law may cover them anyway. Source: U.S. Department of Labor: Field Operations Handbook, chapter 30 (section 30c15).
Medicare can take money back from deposits
When Medicare decides it overpaid the agency, its contractor sends a demand letter and can take the money back by cutting future payments. So a deposit may be smaller than the claims it pays, and the remittance shows what was held back. Interest starts if the debt isn't paid in full within 30 days of the letter. The bookkeeper books each offset against the right claim and keeps the CFO's list of open demands current. Source: CMS Medicare Learning Network: Medicare overpayments fact sheet (MLN006379).
Every dollar needs a service line and a branch
Skilled home health and private-pay personal care share a bank account, but the money comes in different ways. Medicare and Medicaid plans pay claims. Families pay invoices. Long-term care insurers pay on their own schedules. Code every deposit, payroll entry and mileage payment to its service line and branch. Then the CFO can see which part of the agency made money this month.
Patient names ride along with the money
Remittances and insurer checks name patients and the care they got, which makes them protected health information under HIPAA. Treat private-pay invoices the same way. An outside accounting firm that sees this information is a business associate and needs a written agreement first. Send auditors and tax preparers only what they need. Source: 45 CFR 160.103: Definitions, including business associate (Cornell LII).
How much home health bookkeepers make
The closest BLS group for home health bookkeepers is bookkeeping, accounting, and auditing clerks. Bookkeeping, accounting, and auditing clerks who work for home health care agencies earned a median of $24.07 an hour ($50,060 a year) in May 2025, according to the Bureau of Labor Statistics. That’s about the same as the $50,670 median for bookkeeping, accounting, and auditing clerks in all industries. About 4,400 of the 1,373,680 bookkeeping, accounting, and auditing clerks in that survey work for home health care agencies.
Hourly or salaried. Close weeks and cost report season run long, so settle with HR how those extra hours are handled before you hire.
Home health care agencies
$50,060$50,060 median Middle half $44,550–$58,600 10th–90th $37,350–$72,870
All industries
$50,670$50,670 median Middle half $43,520–$61,470 10th–90th $36,000–$74,550
$30k$40k$50k$60k$70k$80k
10th–90th percentileMiddle halfMedianAnnual pay, May 2025. Source: BLS Occupational Employment and Wage Statistics.
Annual pay by percentile
Group
10th
25th
Median
75th
90th
Home health care agencies
$37,350
$44,550
$50,060
$58,600
$72,870
All industries
$36,000
$43,520
$50,670
$61,470
$74,550
Skills to hire for, and what you can teach
Hire for these
Reconciles bank, card and payroll accounts each month and can explain every difference
Matches deposits to remittances and invoices line by line
Spots a duplicate or padded mileage log and asks about it calmly
Handles remittances and payroll files without sharing what's in them
Works to a close calendar and hits its dates
Builds a reconciliation in a spreadsheet from scratch
Teach these on the job
Reading Medicare and Medicaid remittances, offsets included
Your accounting software, chart of accounts and branch codes
Your mileage policy and the app or form staff use to log trips
Your private-pay invoicing and deposit process
The schedules your outside accountants need for audits, tax returns and the cost report
Most agencies run the ledger on QuickBooks Online or Sage Intacct, pull remittance and deposit reports from the EMR's billing screens, and collect mileage through an expense app or the scheduling system. Ask candidates whether they have matched Medicare or insurer remittance files to bank deposits, and how they handled one that didn't match.
Home health bookkeeper interview questions
They have their own page: 6 questions that test this job, what strong and weak answers sound like, and a work exercise to run with your finalists.
The template's four targets are blank. Track a few closes first, then agree on dates and error limits with the CFO.
Month-end close on schedule
Log the day each month's books are closed and handed to the CFO, next to the target day on the close calendar. When it slips, note the cause, such as late remittance files, payroll corrections or a missing bank feed.
Reconciliations completed on time
Accounts reconciled, reviewed and signed by the due date on the close checklist, divided by accounts due. Include every bank, card and payroll account, plus any clearing accounts.
Mileage reimbursement errors
Mileage payments fixed after payout, plus duplicate or unsupported logs caught before payout, each pay period. Check a sample of logs against visit times in the EMR or EVV system.
Vendor payments made on time
Pull the late-payment list from accounts payable each month and total any late fees. Watch supply and software vendors closely, since an EMR account put on hold stops charting in the field.
Career path
Payroll or accounts payable clerkLearns approvals, account coding and the payroll cycle for an hourly field staff.
BookkeeperKeeps the ledger, mileage and reconciliations right for the CFO.
Payroll and accounting managerOwns caregiver payroll, mileage and the close for every branch.
Chief financial officerLeads finance, cash and payer strategy, often after running accounting for years.
Who handles a deposit that doesn't match the claims?
Both the bookkeeper and the billing specialist, from different sides. Billing owns the claims: what was sent, what the payer said and what still needs an appeal. The bookkeeper owns the ledger: what reached the bank and where it was posted. When a deposit and the remittance don't agree, they sit down with both reports before the books close, and billing chases the payer.
How much does a home health bookkeeper make?
Bookkeeping, accounting, and auditing clerks who work for home health care agencies earned a median of $24.07 an hour ($50,060 a year) in May 2025, according to the Bureau of Labor Statistics. The middle half earned between $44,550 and $58,600 a year. Pay also depends on your local market, experience and overtime.
What should the bookkeeper hand the CFO at month-end?
Reconciled bank, card and payroll accounts. A deposit log tied to remittances and private-pay invoices. A list of open Medicare demand letters and offsets. Accruals for payroll and mileage earned but not yet paid, and for supplies received but not yet billed. Aged payables. Last, a short note on anything that didn't tie out and what the bookkeeper did about it.
Can one person run payroll and keep the books?
In a small finance team one person often does both. If you can, split the steps so one person enters payroll and another reconciles the payroll account. Caregiver payroll is large and hourly, with mileage, travel time and overtime mixed in, so a second person reviewing it finds mistakes while they are still cheap to fix.
What does the bookkeeper do for the Medicare cost report?
The CFO or an outside accountant prepares it. Medicare's cost report rules expect financial records and statistics that support the costs reported. So the bookkeeper supplies clean books: costs coded to the right accounts and branches, payroll split by discipline, and schedules that tie to the ledger. Keep invoices, payroll records and reconciliations where a reviewer can find them.
