Home health chief financial officer job description
A home health CFO manages cash coming in from Medicare, Medicaid, insurers and families, who all pay on different clocks. The CFO oversees billing and payroll, builds branch budgets, oversees the Medicare cost report and shows leaders what a rate change does to each service line.
By the HireBus team · Updated · Pay data: BLS, May 2025
Median pay, home health care agencies · BLS, May 2025
We're looking for a CFO to run the finances of a home health and home care agency. You'll manage cash across Medicare, Medicaid, insurance, and private pay, oversee billing and payroll, build branch budgets, and give leadership the numbers they need to decide where to grow and where to cut.
2. Essential Duties and Responsibilities
Manage cash flow across payers that pay on very different timelines, from Medicare to private-pay families.
Oversee billing, collections, and payroll, and lead the Billing Specialist and Bookkeeper.
Build yearly budgets by branch and service line, and report monthly results against them.
Prepare or oversee the annual Medicare cost report [with your outside accountant].
Model how Medicare payment updates, Medicaid rate changes, and new payer contracts affect each service line.
Set payroll rules with HR so caregivers are paid correctly for overtime and travel time between clients under federal and state wage laws.
3. Key Tasks / Daily Activities
Check the cash position, deposits, and claims waiting on payment.
Review denials, unbilled visits, and missing signed orders that are holding up claims.
Approve payroll and review overtime and mileage costs.
Answer leadership questions on pricing, payer mix, and the cost of opening a new territory.
4. Key Performance Indicators (KPIs)
Days sales outstanding: [your target].
Claims paid on first submission: [your target].
Days cash on hand: [your target].
Budget variance by branch: [your target].
Write-offs as a share of revenue: [your target].
5. Required Qualifications and Skills
Bachelor's degree in accounting or finance.
[8+] years of finance leadership, including health care revenue cycle work.
Knows how Medicare pays for home health, including the Patient-Driven Groupings Model (PDGM).
Experience with Medicaid billing, managed care contracts, and private-pay accounts receivable.
Strong with accounting software and spreadsheets, and comfortable presenting to owners and lenders.
6. Preferred Experience
CPA license.
Experience with home health cost reports and payer audits.
Has worked with home health or home care billing systems such as [your EMR or billing software].
Experience with a credit line, bank covenants, or an acquisition.
7. Physical Requirements
Sitting at a computer for long periods, with frequent meetings.
Occasional travel to branch offices.
With or without reasonable accommodation.
8. Work Environment and Schedule
Office-based, with occasional travel to branch offices.
Regular hours: [Monday through Friday], with longer days at month-end and year-end close.
Hybrid or remote work: [your policy].
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 chief financial officer 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
Medicare's payment rules set the calendar for home health finance. A notice filed a few days late or a claim held for a missing signature costs real money, and four kinds of payers each pay on their own timing.
Medicare pays by the 30-day period
Under the Patient-Driven Groupings Model, Medicare pays a set rate for each 30-day period of care, not for each visit. The rate is adjusted for things like where the patient came from, timing, the clinical group, function and other conditions. A period with too few visits is paid per visit instead. So the CFO tracks visit patterns as closely as admissions. Source: CMS: Home health prospective payment system.
Five days to file the notice of admission
Medicare requires a Notice of Admission within 5 calendar days after the start of care. File late, and Medicare won't pay for the days before the notice: the period's payment drops by one thirtieth for each day from the start of care until it's filed. Those days are the agency's loss, and it can't bill the patient for them. Intake and billing need to work that clock every day. Source: 42 CFR 484.205: Basis of payment (Cornell LII).
Some states add a claim review
In Illinois, Ohio, Texas, North Carolina, Florida and Oklahoma, Medicare's Review Choice Demonstration has home health agencies choose pre-claim review or postpayment review. An agency in one of those states needs complete records before claims go out, and a cash plan that allows for the review. Agencies with high approval rates can earn lighter review options later. Source: CMS: Review Choice Demonstration for Home Health Services.
The cost report has a hard deadline
A Medicare-certified agency files a cost report every year, due by the end of the fifth month after its cost reporting year ends. Set up the chart of accounts and visit counts so the report comes straight from the books, not from a rebuild in month four. If an outside accountant prepares it, book their time well before the deadline. Source: 42 CFR 413.24: Adequate cost data and cost finding (Cornell LII).
Each payer runs on its own clock
Medicare pays once for each 30-day period, after the final claim. Medicaid pays through state waiver programs or managed care plans, each on its own schedule and rules. Long-term care insurers have their own claim steps, and families pay on the terms you set. Caregiver payroll goes out on time no matter who is late, so the cash forecast is built payer by payer. Source: 42 CFR 484.205: Basis of payment (Cornell LII).
How much home health chief financial officers make
The closest BLS group for home health chief financial officers is chief executives. Chief executives who work for home health care agencies earned a median of $195,580 a year ($94.03 an hour) in May 2025, according to the Bureau of Labor Statistics. That’s below the $213,990 median for chief executives in all industries. About 810 of the 204,350 chief executives in that survey work for home health care agencies.
Salary with an annual bonus. Weight the bonus toward collections, receivable days and an on-time cost report, since booked revenue in home health can shrink after denials and adjustments.
Home health care agencies
$195,580$195,580 median Middle half $114,750–$361,060 10th–90th $91,330–$426,770
All industries
$213,990$213,990 median Middle half $129,540–$356,200 10th–90th $75,700–$507,730
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
$91,330
$114,750
$195,580
$361,060
$426,770
All industries
$75,700
$129,540
$213,990
$356,200
$507,730
Skills to hire for, and what you can teach
Hire for these
Has run a health care revenue cycle with Medicare as a major payer
Knows PDGM, low-visit periods, the Notice of Admission and what holds up a final claim
Forecasts cash payer by payer, not as one blended number
Turns the monthly close into a short story owners and branch leaders understand
Catches payroll errors on overtime, travel time and mileage before caregivers do
Teach these on the job
Your state's Medicaid waiver billing and managed care portals
Your EMR's billing module and claim edits
Your branch cost centers and visit statistics
Billing steps for the long-term care insurers your clients use
Your lender's reporting and covenant calendar
Billing runs through the agency's EMR, for example Axxess, WellSky or HCHB, and a claims clearinghouse. Payroll runs on a system fed by EVV and visit data, and the general ledger sits in Sage Intacct, Microsoft Dynamics or similar accounting software. Ask candidates which EMR billing modules they have closed a month in.
Home health chief financial officer 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.
Start each target from your trailing year. Keep Medicare and private pay apart where the payers behave differently, and go over the numbers with the CEO monthly.
Days sales outstanding
Accounts receivable divided by average daily net revenue, figured each month. Run it by payer too, since Medicare, Medicaid plans, insurers and families collect at different speeds.
Claims paid on first submission
Claims paid without a rejection, denial or resubmission, divided by claims sent, by payer each month. Sort the misses by cause: eligibility, authorization, missing orders or an EVV mismatch.
Days cash on hand
Cash you can use freely, divided by what an average day of operating costs. Check it each week against the next payroll dates, because caregiver payroll can't wait for a slow payer.
Budget variance by branch
Actual revenue, labor and mileage against budget for each branch every month. Ask the branch leader for a short note on any line that misses by more than the limit you set.
Write-offs as a share of revenue
Bad debt and contractual write-offs, tracked apart, divided by gross revenue each quarter. Read the reasons, since late notices of admission, missing signatures and missed filing limits can be fixed upstream.
The federal answer is changing. A 2013 Labor Department rule stopped agencies from claiming the companionship and live-in exemptions. In July 2025 the department proposed giving those exemptions back to agencies, and as of October 2026 that change is not final. State law may still require minimum wage and overtime. For workers federal wage law covers, travel from one client's home to another in the middle of a workday is work time. Check with counsel before you change payroll.
How much does a home health chief financial officer make?
Chief executives who work for home health care agencies earned a median of $195,580 a year ($94.03 an hour) in May 2025, according to the Bureau of Labor Statistics. The middle half earned between $114,750 and $361,060 a year. Pay also depends on your local market, experience and bonus terms.
How do Medicare rate updates reach the budget?
CMS updates the home health payment rate every calendar year. An agency that doesn't send in its quality data gets a smaller update that year. Medicare's period payment is also adjusted for local wages and case mix, so the CFO models each year's change branch by branch and has it in the budget before January.
How does a home health CFO work with the COO?
The COO controls the schedule, and the CFO sees what it costs. Each week they should look at overtime, mileage, visits not yet ready to bill and open shifts together. The CFO brings the cost of each choice. The COO brings what it takes to staff the visits. Pay rules for travel time and overtime are set by the CFO and HR together.
What holds up a home health claim?
Look on your own side first. A final Medicare claim can't go out until the plan of care is signed and dated, and the agency must send OASIS data for Medicare to set the payment. Medicaid plans and insurers add their own billing rules on top of that. A CFO who sorts unbilled visits by reason each week can see which team is holding up cash.
