A hospital revenue cycle specialist sends a critical access hospital's claims, chases the ones that don't get paid, and works denials and appeals. They post payments, take patient billing calls and handle refunds, under critical access billing rules that larger hospitals don't use.
By the HireBus team · Updated · Pay data: BLS, May 2025
We're hiring a revenue cycle specialist to get our hospital paid correctly for the care it gives. You'll submit and follow up on claims, work denials and appeals, post payments, and answer patient billing questions. Medicare, Medicaid, Medicare Advantage and commercial plans each have their own rules for a critical access hospital, and you'll learn them well.
2. Essential Duties and Responsibilities
Submit clean institutional and professional claims through [your clearinghouse], and fix edits before they reach the payer.
Follow up on unpaid claims by payer and age, and resolve them before timely filing limits pass.
Work denials by root cause, write appeals, and send trends to patient access, coding or the department involved.
Post insurance and patient payments and adjustments, and reconcile deposits with finance.
Bill swing bed, observation, ED and outpatient services under critical access hospital rules.
Answer patient billing calls, set up payment plans, and screen for financial assistance under your policy.
Work credit balances and refunds, including Medicare credit balance reporting.
3. Key Tasks / Daily Activities
Work the claim edit queue and release clean claims.
Check claim status by phone or portal, and correct and resubmit claims.
Post electronic remittances and work zero-pay and partial-pay lines.
Write appeal letters with records and authorizations attached.
Note every account action in [your billing system].
4. Key Performance Indicators (KPIs)
Clean claim rate: [your target].
Initial denial rate: [your target].
Denials overturned on appeal: [your target].
Aged accounts receivable: [your target].
Timely filing write-offs: [your target].
5. Required Qualifications and Skills
High school diploma or equivalent; an associate degree in business or health information is a plus.
[2+] years of hospital or medical billing and collections experience.
Working knowledge of Medicare, Medicaid and commercial payer rules, remittance codes and appeals.
Experience with a clearinghouse and payer portals.
Patient, clear phone manner and accurate account notes.
6. Preferred Experience
Experience with critical access hospital billing, including Method II and swing bed claims.
Certified Revenue Cycle Representative (CRCR) from HFMA.
Coding knowledge or a coding certification.
Experience with Medicare Advantage denials and payer contract terms.
7. Physical Requirements
Sit and work at a computer and phone for most of the day.
Use a keyboard and headset for long periods.
With or without reasonable accommodation.
8. Work Environment and Schedule
Monday through Friday: [hours], with [hybrid or remote work after training, if you offer it].
Business office setting with steady phone and portal work.
Busier weeks at month-end and when payer rules change.
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 revenue cycle specialist 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 billing works differently at a critical access hospital
The claims here follow critical access rules that a biller from a clinic or a big hospital may never have used. And in a small office, one person may handle every payer and every federal report.
Medicare gives you one year to file
Medicare's deadline for a claim is one calendar year after the date of service. Medicare allows more time only in a few cases, such as a mistake by a Medicare contractor, or coverage that was granted late and dated back. Medicaid and each commercial contract set their own limits. The specialist tracks every unbilled and rejected claim against its deadline, so nothing turns into a write-off. Source: 42 CFR 424.44, time limits for filing Medicare claims (Cornell LII).
One claim can carry the provider's work too
If your hospital uses Medicare's optional billing method, called Method II, its outpatient claim can also carry the provider's work. That's for providers who have signed their billing over to the hospital. Those lines get their own HCPCS codes in revenue codes 096X, 097X or 098X. When a line's provider isn't the one named on the claim, that line must carry the provider's own NPI. Source: CMS: Medicare Claims Processing Manual, chapter 4, section 250.
Credit balances still go back to Medicare
On December 1, 2024, CMS stopped asking for a quarterly credit balance report, Form CMS-838. The duty to report overpayments the hospital finds on its own didn't end, and the form is now filed when one turns up. So the specialist still works the credit balance list, sorts out whether each refund belongs to Medicare, another insurer or the patient, and gets Medicare's share back on time. Source: CMS MLN Connects, December 19, 2024: quarterly credit balance reports no longer required.
Appeals have deadlines, and plans follow Medicare rules
Medicare's first appeal step, a redetermination, has to be asked for within 120 days of receiving the denial notice. A Medicare Advantage plan's deadline is in its denial notice or your contract. These plans have to follow traditional Medicare's coverage rules, including its rules for inpatient stays and skilled nursing care, unless Medicare Advantage law says otherwise. When a plan denies swing bed days or an inpatient stay, cite those rules in the appeal. Attach the record and the approval. Source: 42 CFR 422.101, Medicare Advantage basic benefits (Cornell LII).
One person, every payer
A small business office has no separate Medicare or Medicaid team. One specialist may work Medicare, the state Medicaid plan, a few Medicare Advantage plans, the big local employer's plan and workers' comp, all in one day. Keep a sheet for each payer: its filing limit, appeal steps, portal login and who to call.
How much hospital revenue cycle specialists make
The closest BLS group for hospital revenue cycle specialists is billing and posting clerks. Billing and posting clerks who work for general medical and surgical hospitals earned a median of $23.46 an hour ($48,810 a year) in May 2025, according to the Bureau of Labor Statistics. That’s about the same as the $48,500 median for billing and posting clerks in all industries. About 35,330 of the 404,060 billing and posting clerks in that survey work for general hospitals.
Hourly. If you add a collections incentive, pay it on team results under your written policy, so no one gains by steering patients away from financial assistance.
General hospitals
$48,810$48,810 median Middle half $44,830–$59,730 10th–90th $38,800–$65,330
All industries
$48,500$48,500 median Middle half $42,840–$58,290 10th–90th $37,290–$67,710
$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
General hospitals
$38,800
$44,830
$48,810
$59,730
$65,330
All industries
$37,290
$42,840
$48,500
$58,290
$67,710
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
Reads an electronic remittance and knows what each adjustment code means for the account
Writes a short appeal letter that cites the rule and attaches the right records
Follows up by phone and portal without letting a claim sit
Notes every account action so the next person can pick it up
Talks a worried patient through a bill and a payment plan
Teach these on the job
Your clearinghouse, claim scrubber and billing system
Critical access claims: Method II lines, swing bed and observation stays
Each payer's filing limit and appeal steps
Your financial assistance and refund policies
When to file a Medicare credit balance report, and how
Specialists work in the billing system's claim and follow-up queues, a clearinghouse, and the web portals of each payer and your Medicare contractor, and post remittances electronically. Experience on your EHR's billing side shortens training the most, so list the system.
HFMA, the Healthcare Financial Management Association, awards the Certified Revenue Cycle Representative credential. It covers the whole cycle: before, during and after the visit. HFMA suggests a year or more of revenue cycle work but doesn't require it. The test is online, with 75 multiple-choice questions in one sitting. It shows broad knowledge. It doesn't prove critical access billing skill, so test that in the interview.
How much does a hospital revenue cycle specialist make?
Billing and posting clerks who work for general medical and surgical hospitals earned a median of $23.46 an hour ($48,810 a year) in May 2025, according to the Bureau of Labor Statistics. The middle half earned between $44,830 and $59,730 a year. Pay also depends on your local market, experience and overtime.
How is a revenue cycle specialist different from a medical coder?
The coder reads the chart and assigns the codes. The specialist takes the finished claim, sends it, follows it to payment and fixes or appeals what comes back. Both read the same denial codes, so have them meet each week on the denials that land between their jobs.
What if we find out Medicare overpaid us years ago?
Report it and pay it back. Medicare's rule reaches back six years from when the money came in. You have 60 days from identifying it, or until the matching cost report is due if that comes later. The deadline can be put on hold, at most until 180 days after you found it, while you look into whether the same cause led to others. That search has to be prompt and honest. Tell the business office manager and the CFO right away, and keep notes on how you found it.
What experience should a revenue cycle specialist have?
Hospital claims on the UB-04, not just doctor's office claims on the CMS-1500. Someone who knows hospital claims, remittance codes and the Medicare contractor's portal will start faster. In the interview, hand over a sample remittance. Ask what happened to the claim and what they'd do next.
