A hospital business office manager leads a critical access hospital's registration, coding and billing staff, so claims go out clean and get paid. They clear stuck claims, chase denials and old balances, and keep swing bed and Method II billing right.
By the HireBus team · Updated · Pay data: BLS, May 2025
We're hiring a business office manager to run patient access, coding and billing at our critical access hospital. You'll lead the registration, coding and billing staff, clear what holds up claims, work denials and aging, and keep swing bed, Method II and rural health clinic billing right. The CFO sets financial goals; you run the daily work that meets them.
2. Essential Duties and Responsibilities
Lead patient access representatives, medical coders and revenue cycle specialists, and set daily work queues and goals.
Review accounts receivable by payer and age each week, and assign follow-up on the oldest and largest accounts.
Find the root causes of denials with patient access, coding and clinical departments, and track each fix.
Maintain the chargemaster with department leaders, and update codes and prices when services or payer rules change.
Prepare the Medicare bad debt listing and credit balance reports for the CFO and the cost report preparer.
Give good faith estimates to uninsured and self-pay patients as the No Surprises Act requires.
Run financial assistance applications, payment plans and collection agency placements under hospital policy.
3. Key Tasks / Daily Activities
Check the discharged-not-final-billed report and clear what's holding each claim.
Review the prior day's cash, deposits and point-of-service collections.
Take escalated patient billing calls and complaints.
Meet with staff on payer problems, such as a Medicare Advantage plan denying swing bed days.
Cover registration, coding follow-up or billing work when someone is out.
4. Key Performance Indicators (KPIs)
Discharged not final billed days: [your target].
Cash collected against goal: [your target].
Denials by root cause: [your target].
Registration errors caught before billing: [your target].
Billing complaints from patients: [your target].
5. Required Qualifications and Skills
[5+] years of hospital billing, registration or revenue cycle work, including [2+] years supervising staff.
Working knowledge of institutional and professional claims, remittance codes, and Medicare, Medicaid and commercial payer rules.
Experience with critical access hospital billing, such as swing beds, Method II or rural health clinics.
Strong Excel skills and experience with [your EHR and billing system].
Clear, calm communication with patients, staff, payers and department leaders.
6. Preferred Experience
Certified Revenue Cycle Representative (CRCR) from HFMA, or Certified Healthcare Access Manager (CHAM) from NAHAM.
Associate or bachelor's degree in business, accounting or health information management.
Coding knowledge, or a credential such as CPC or CCS.
Experience with chargemaster reviews and price transparency files.
7. Physical Requirements
Work at a desk and computer for most of the day, with walks to registration areas and departments.
With or without reasonable accommodation.
8. Work Environment and Schedule
Hospital business office, weekday schedule: [hours].
Longer days at month-end and before cost report deadlines.
A team that covers registration on every shift, including nights and weekends.
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 business office manager 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.
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How a critical access hospital changes the business office
Any business office manager watches claims and cash. At a 25-bed hospital that Medicare pays on cost, a missed charge or a thin collection file can cost money at cost report time, long after the claim was paid.
Charges split the cost Medicare pays
Medicare pays this hospital on cost, but charges set Medicare's share of that cost. Take an ancillary department such as lab or imaging. Medicare patients' charges there, divided by all patients' charges, decide how much of the department's cost Medicare pays. So a lab charge missed on a Medicare patient lowers what Medicare pays. The manager keeps the chargemaster current and works missing-charge reports with each department head. Source: 42 CFR 413.53, apportioning cost to Medicare (Cornell LII).
Bad debt claims need a paper trail
Medicare can repay some unpaid deductibles and coinsurance as bad debt, but only when the file proves the effort. For a patient who isn't indigent, the effort has to match what you do for other patients. The first bill goes out within 120 days of the last remittance, collection lasts at least 120 days, and each payment restarts that clock. Accounts placed with a collection agency must come back before you claim them. Source: 42 CFR 413.89, Medicare bad debts (Cornell LII).
Collections wait on financial assistance
If your hospital is a 501(c)(3) nonprofit, federal tax rules limit what the IRS calls extraordinary collection actions. They include reporting a patient to a credit bureau, garnishing wages and, in most cases, selling the debt. Before any of them, the hospital must make reasonable efforts to find out if the patient qualifies for help. That includes waiting at least 120 days after the first bill sent after care, and giving written notice at least 30 days before the first such step. Hold your collection agency to the same timeline. Source: IRS: Billing and collections, Section 501(r)(6).
Self-pay estimates run on a clock
When an uninsured or self-pay patient books a CT scan, therapy or a procedure, the No Surprises Act rules set the deadline for a written good faith estimate. Booked three to nine business days ahead, it's due within one business day. Booked ten or more business days ahead, it's due within three. Any question about cost counts as a request. The manager decides who builds each estimate and how it's tracked. Source: 45 CFR 149.610, good faith estimates for uninsured or self-pay patients (Cornell LII).
Registration never closes, so neither does the job
The ER needs a registrar around the clock, and nights and weekends may have just one. The manager writes the night procedures, trains people to work alone, and takes the call when a shift opens up or a payment question can't wait. When someone is out, the manager may register patients or work claims themselves.
How much hospital business office managers make
The closest BLS group for hospital business office managers is First-Line supervisors of office and administrative support workers. First-Line supervisors of office and administrative support workers who work for general medical and surgical hospitals earned a median of $36.41 an hour ($75,720 a year) in May 2025, according to the Bureau of Labor Statistics. That’s above the $69,500 median for First-Line supervisors of office and administrative support workers in all industries. About 43,670 of the 1,436,680 First-Line supervisors of office and administrative support workers in that survey work for general hospitals.
Usually salaried. If you pay a bonus, measure the team on unbilled days, cash against goal and denial trends, which they can move and your reports can prove.
General hospitals
$75,720$75,720 median Middle half $61,300–$91,770 10th–90th $50,000–$107,490
All industries
$69,500$69,500 median Middle half $55,950–$85,090 10th–90th $45,610–$104,710
$25k$50k$75k$100k$125k
10th–90th percentileMiddle halfMedianAnnual pay, May 2025. Source: BLS Occupational Employment and Wage Statistics.
Annual pay by percentile
Group
10th
25th
Median
75th
90th
General hospitals
$50,000
$61,300
$75,720
$91,770
$107,490
All industries
$45,610
$55,950
$69,500
$85,090
$104,710
These figures cover general medical and surgical hospitals of every size. Rural hospitals often pay less than city hospitals. Post a real range for your market in the ad.
Skills to hire for, and what you can teach
Hire for these
Has run hospital accounts receivable by payer and age, not just worked one desk of it
Reads a remittance and can tell whether a denial started at registration, coding or the chart
Has billed critical access work such as swing beds, Method II or a rural health clinic
Builds a clear Excel report from raw billing system data
Coaches a registrar, a coder and a biller in the same week, and can cover each job
Explains a bill to an upset patient in plain words
Teach these on the job
Your EHR's work queues, unbilled report and claim scrubber
Your Medicare contractor's portal and your state Medicaid program's rules
Your financial assistance, payment plan and collection policies
Who owns each chargemaster line and how each department enters charges
What your cost report preparer needs from the business office, and when
Expect the EHR's patient accounting module, a claim scrubber or clearinghouse, payer portals, the Medicare contractor's portal and Excel. Say which EHR you run and whether any coding or billing goes to an outside firm, since that decides whether the manager leads people, a vendor or both.
Hospital business office manager 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 CFO's cash plan and last year's billing reports give you a starting point for each target, and the monthly finance meeting is where to check them.
Discharged not final billed days
Dollars in discharged accounts not yet billed, divided by average daily gross revenue. Split it by what holds each account: coding, a missing charge, documentation or a registration fix.
Cash collected against goal
Payments posted each month against the CFO's cash goal, with insurance cash and patient payments on separate lines so a drop in one can't hide behind the other.
Denials by root cause
Denied claims and dollars each month by cause, such as eligibility, authorization, coding or medical necessity, with each cause assigned to the department that can fix it.
Registration errors caught before billing
Errors the claim scrubber or a pre-bill review catches, by type and by registrar. Compare them with the errors that slipped through and came back as denials.
Billing complaints from patients
Log every complaint about a bill, from calls, letters and the patient portal, with its cause and how it was settled. Read the log monthly for patterns.
The Certified Healthcare Access Manager credential comes from NAHAM, the National Association of Healthcare Access Management. NAHAM updated its application rules in 2025. Candidates now need two years of management work in healthcare or finance. They also need a supervisor's letter or 30 hours of training in the past 24 months. It speaks to patient access leadership. If your manager will also run billing and coding, ask about those too.
How much does a hospital business office manager make?
First-Line supervisors of office and administrative support workers who work for general medical and surgical hospitals earned a median of $36.41 an hour ($75,720 a year) in May 2025, according to the Bureau of Labor Statistics. The middle half earned between $61,300 and $91,770 a year. Pay also depends on your local market, experience and overtime.
Can we waive copays for patients who can't afford them?
Yes, case by case. HHS's Office of Inspector General (OIG) warns that waiving copays as a routine could raise problems under the Anti-Kickback Statute, and you may not advertise that you forgive them. Federal rules allow a waiver that isn't routine or advertised once you decide in good faith that a patient is in financial need, or after reasonable collection efforts fail. In a town where staff and patients know each other, put the rule in your financial assistance policy so it's applied the same way for everyone. Have a healthcare attorney review it.
Does a business office manager need to know coding?
Enough to read a denial and know whether a code caused it. The template lists a CPC or CCS as a bonus rather than a requirement. What matters more is knowing how a code, a charge and a registration field all land on the same claim, so each problem goes to the person who can fix it.
Should a small hospital outsource billing or coding?
Some do, for coding backlogs or old balances. If you do, the business office manager still owns the results: setting work queues, auditing the vendor's accounts and keeping the denials list. Write the reports you expect into the contract, and keep someone in-house who knows your swing bed and Method II rules.
