A critical access hospital CFO runs the money: cash, budgets, the audit and the yearly Medicare cost report, which drives much of what Medicare pays. In a hospital this small, the CFO also leads billing and buying and explains the numbers to the CEO and board.
By the HireBus team · Updated · Pay data: BLS, May 2025
Annual pay: 10th percentile $176,440, middle half $259,990 to $535,040, 90th percentile $713,160. Source: BLS Occupational Employment and Wage Statistics, May 2025.
Reports to
Chief Executive Officer
Department
Finance
Schedule
Weekdays, long hours at close and audit · Month-end close, the audit and the cost report deadline bring long days, plus evening finance committee meetings
Also called
Vice president of finance · Director of finance · CFO and controller
We're hiring a chief financial officer to run the finances of our critical access hospital. Medicare pays us based on reasonable cost, so the cost report matters as much as the budget. You'll own the cost report, cash, budgets, audits and the business office, and you'll explain the numbers plainly to the CEO and the board.
2. Essential Duties and Responsibilities
Prepare or oversee the annual Medicare cost report with your outside reviewer, and settle interim rates and audits with the Medicare Administrative Contractor.
Build the operating and capital budgets with department leaders, and report results against them each month.
Present monthly financial statements, cash flow and key ratios to the CEO, finance committee and board.
Lead the business office manager and supply chain coordinator, and act on denial, accounts receivable and supply cost trends.
Manage cash, lender reporting, debt covenants and the investment policy.
Run the annual financial audit, and approve chargemaster and price transparency updates.
Model the cost and payment of services such as swing beds, obstetrics, clinics and visiting specialists before the board decides.
3. Key Tasks / Daily Activities
Check cash, deposits and the inpatient, swing bed and observation census.
Meet with the business office manager on billing holds, denials and large unpaid accounts.
Approve payroll, purchase orders and vendor payments above department limits.
Track worked hours against budget with department leaders, including overtime and agency staff.
Answer questions from auditors, cost report reviewers, payers and the Medicare contractor.
4. Key Performance Indicators (KPIs)
Days cash on hand: [your target].
Days in accounts receivable: [your target].
Cost report filed on time: [your target].
Budget variance by department: [your target].
Denial write-offs: [your target].
5. Required Qualifications and Skills
Bachelor's degree in accounting, finance or business.
[5+] years of hospital finance experience, including [2+] years leading a finance or business office team.
Hands-on Medicare cost report experience, ideally for a critical access hospital.
Working knowledge of GAAP, the hospital revenue cycle and payer contracts.
Strong Excel skills and experience with [your EHR] or another hospital financial system.
6. Preferred Experience
CPA, or a master's degree in business or healthcare administration.
Certified Healthcare Financial Professional (CHFP) from HFMA.
Experience with 340B, rural health clinic cost reports or provider-based billing.
Experience with USDA, bond or bank financing for hospital buildings and equipment.
Experience presenting to a public or nonprofit hospital board.
7. Physical Requirements
Sit and work at a computer for most of the day.
Walk the hospital to meet with department leaders.
With or without reasonable accommodation.
8. Work Environment and Schedule
Hospital office, weekday schedule: [hours].
Longer hours around month-end close, the annual audit and cost report deadlines.
Evening finance committee and board meetings: [schedule].
Administrator-on-call rotation: [rotation, if any].
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
What makes critical access hospital finance different
Hospital CFOs everywhere close the books and watch cash. Here Medicare pays on cost, so how you count your costs changes how much money comes in.
Medicare pays on cost, not a set rate
Medicare pays a critical access hospital for most inpatient, outpatient and swing bed care based on its reasonable costs. It skips the fixed rates most hospitals get paid under. So the CFO's job is to get every cost into the right department and prove it, because that is how the hospital gets paid. Source: CMS: Information for Critical Access Hospitals (MLN006400, December 2025).
The cost report has a hard deadline
A hospital paid on cost must back its numbers with financial and statistical records that auditors can check. The cost report is due five months after the fiscal year closes, on the last day of that month. The Medicare contractor grants more time only for events you can't control, such as a flood or fire. Source: eCFR: 42 CFR 413.24, adequate cost data and cost finding.
One billing choice changes outpatient income
Under the optional method, known as Method II, the hospital bills both the facility and the doctor's side of outpatient visits, for practitioners who sign their billing over to it. The choice stays until the hospital ends it in writing at least 30 days before its next cost report year starts. Model it before the board signs off. Source: CMS: Information for Critical Access Hospitals (MLN006400, December 2025).
Your prices are public
Federal price transparency rules cover licensed hospitals, including yours. You post a machine-readable file of standard charges for every item and service. You also post a patient-friendly list of shoppable services. CMS audits a sample of hospitals, looks into complaints and can fine those that fall short. It has enforced its updated file rules since April 1, 2026. Source: CMS: Hospital price transparency.
The EHR can cost you Medicare money
Medicare cuts the cost-based payment a little when a critical access hospital misses its Promoting Interoperability rules for electronic records. By law, hardship exceptions run out after five years. Since 2026, the hospital must also attest that it manages security risks and does a yearly SAFER Guides self-check. The CFO keeps those dates on the calendar with IT. Source: CMS: Information for Critical Access Hospitals (MLN006400, December 2025).
How much hospital chief financial officers make
The closest BLS group for hospital chief financial officers is chief executives. Chief executives who work for general medical and surgical hospitals earned a median of $421,690 a year ($202.74 an hour) in May 2025, according to the Bureau of Labor Statistics. That’s above the $213,990 median for chief executives in all industries. About 3,070 of the 204,350 chief executives in that survey work for general hospitals.
Salaried. Any incentive should rest on things the CFO controls, such as an on-time cost report, audit findings and cash, rather than on patient volume, which the CFO can't move.
General hospitals
$421,690$421,690 median Middle half $259,990–$535,040 10th–90th $176,440–$713,160
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
General hospitals
$176,440
$259,990
$421,690
$535,040
$713,160
All industries
$75,700
$129,540
$213,990
$356,200
$507,730
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 prepared or worked hands-on with a hospital Medicare cost report, not only signed the final copy
Knows how square footage, time studies and patient days move cost from one department to another
Has kept a thin-margin hospital paying its bills through a slow settlement or a payer backlog
Answers a finance committee of local bankers, business owners and teachers without jargon
Leads a small team hands-on and covers their work when someone is out
Teach these on the job
Your Medicare contractor's portal, contacts and audit process
Your chargemaster and which department owns each line
Your lender reports and debt covenants
Your local payers, your state Medicaid program and the Medicare Advantage plans in your area
Your rural health clinic or 340B setup, if you have them
Day to day, expect the EHR's patient accounting and general ledger, Excel, cost report software and the Medicare contractor's online portal. In the posting, mention any rural health clinics or 340B program, since both add reporting the CFO will own.
Your lender's covenants and the board's budget give you most of these targets. Take the rest from your last audited year.
Days cash on hand
Unrestricted cash and investments, measured against what the hospital spends on an average day, leaving out depreciation. Check it weekly, report it monthly, and show it with and without any expected cost report settlement.
Days in accounts receivable
Net patient receivables divided by average daily net patient revenue, split by payer, so a slow Medicare Advantage plan or a Medicaid backlog shows up on its own line.
Cost report filed on time
Yes or no each year against the due date, plus how many adjustments the contractor made at audit and how long final settlement took.
Budget variance by department
Worked hours per patient day, overtime, agency staff and supply cost against budget, by department each pay period, since labor moves faster than the monthly statements show.
Denial write-offs
Dollars written off to denials each month by payer and root cause, kept apart from contractual adjustments and charity care so the trend can't hide.
Career path
Business Office ManagerRevenue cycle leaders with an accounting degree pick up the budget and cost report side.
Controller or reimbursement managerWorks at a larger hospital or a firm that prepares hospital cost reports.
Chief Financial OfficerOwns cash, budgets, the audit and the cost report for one rural hospital.
Chief Executive OfficerFinance leaders who win the board's trust may be asked to run the hospital.
System finance leaderMoves to finance for a regional health system or a bigger hospital.
CHFP stands for Certified Healthcare Financial Professional. It comes from the Healthcare Financial Management Association, and only members can earn it. Candidates finish two modules in order: Business of Health Care, then an Operational Excellence assessment. The template lists it as a plus, like a CPA. Neither one proves cost report skill, so ask about that directly.
How much does a hospital chief financial officer make?
Chief executives who work for general medical and surgical hospitals earned a median of $421,690 a year ($202.74 an hour) in May 2025, according to the Bureau of Labor Statistics. The middle half earned between $259,990 and $535,040 a year. Pay also depends on your local market, experience and bonus terms.
Can an outside firm prepare our cost report?
The template assumes an outside reviewer, and a good one catches what a small team misses. Keep the CFO in charge of what goes in: square footage, salaries by department, time studies and patient days. No firm can fix statistics nobody kept during the year.
Who handles billing, the CFO or the business office manager?
The business office manager runs registration, coding and billing day to day and works the claims. The CFO owns the whole picture: budgets, cash, debt, the audit, the cost report and the board. In this template, the business office manager reports to the CFO.
How do swing beds affect hospital finances?
Medicare pays for swing bed care here on cost, not on the nursing home payment system. It requires a three-day hospital stay first, though starting January 1, 2026 a Medicare model called TEAM waives that for some patients sent by hospitals in the model. Swing beds also share the hospital's 25 beds, so the CFO weighs them against acute care.
