A payment posting specialist records the payments and adjustments that come back after claims go out, matching each remittance to the right patient accounts so the practice can see what was paid, what was adjusted and what is still owed.
Job titles include payment poster and cash poster.
It sits at the back end of the revenue cycle, and this guide covers the work, the posting methods, the settings, the skills and the pay.
What payment posters do
A payment posting specialist works the back end of the claim cycle: once claims go out, this seat records what comes back.
Each remittance a payer sends reports what it paid and what it adjusted, and the poster applies those payments and adjustments to the patient accounts the claims came from.
The remittance is the claim coming back.
CMS defines an institutional claim as one submitted on the ASC X12 837 institutional transaction or paper Form CMS-1450, and a professional claim as one on the ASC X12 837 professional transaction or the CMS-1500 paper form.
The 835 payment and remittance advice is the electronic format that returns against those claims.
When a line comes back unpaid or paid at less than billed, the claim adjustment group codes on the remittance sort it — Contractual Obligation, Payor Initiated Reduction, Patient Responsibility — and the poster records it against the right account.
Amounts coded PR, for Patient Responsibility, are what the account shows as owed by the patient.
BLS counts the work inside the billing and posting clerks occupation (SOC 43-3021), a group that spans all industries and has no medical-only code.
BLS describes billing and posting clerks as workers who calculate charges, generate bills, review documents such as hospital records to calculate fees, and contact customers to get or give account information.
Titles vary by employer: payment posting specialist, payment poster and cash poster all name the posting seat, and combined titles such as payment posting and accounts receivable specialist fold the posting work in with follow-up duties.
Manual posting vs auto posting
Remittances reach the billing system two ways, and that split shapes the day-to-day work.
Manual posting is keyed entry.
The poster reads the remittance — on paper or on screen — and enters each payment, adjustment and denial into the billing system by hand, account by account.
Auto posting is system entry.
The billing software imports the electronic 835 directly and applies its payments and adjustments to the claims on file, and the poster then reviews what posted and clears what did not.
The 835 is the electronic format behind that second mode.
HIPAA's adopted standard for health care payment and remittance advice is the ASC X12 835 (005010X221) under 45 CFR 162.1602 — the electronic remittance advice, or ERA, that payment posters work from.
Every adjustment the 835 reports carries a claim adjustment group code.
X12's current group codes are CO (Contractual Obligation), OA (Other Adjustment), PI (Payor Initiated Reduction) and PR (Patient Responsibility), and they group every adjustment reported on an 835.
Those codes let a system or a human sort the money at a glance: a CO line is a contractual adjustment, a PI line is a payor-initiated reduction, a PR line moves to the patient, and OA covers the rest.
BLS's outlook speaks to this split: employment of billing and posting clerks is expected to rise in fast-growing health care industries, but automated invoice processing software will increase these workers' productivity and reduce overall employment growth.
Transaction rules come from the source
Where payment posters work
Health care is where this occupation is growing.
In BLS Employment Projections, 178,100 of the 418,000 billing and posting clerk jobs in 2025 — 42.6% — were in health care and social assistance.
BLS projects health care employment of these clerks to grow 6.6% to 190,000 by 2035, even as the occupation overall stays essentially flat.
Inside health care, the posting work exists wherever claims go out and money comes back: physician practices and specialty groups, hospitals and health systems, ambulatory surgery centers, labs and imaging centers, and home health and hospice agencies.
Billing companies and RCM vendors run this work for client practices, so remittances there can span many payers and more than one billing system.
Skills payment posters build
BLS describes the entry path for financial clerks — the group that includes billing and posting clerks — plainly: a high school diploma or equivalent is typically required for most financial clerk jobs, and these workers typically learn their duties through on-the-job training.
BLS lists the qualities it flags for financial clerks: communication skills, for explaining policies and procedures to colleagues and customers; math skills, for calculating charges and updating financial records; and organizational skills.
The role-specific knowledge is the remittance itself: reading an 835 line by line, knowing what each claim adjustment group code does to an account balance, and posting patient-responsibility amounts to the right accounts.
That on-the-job training happens at the desk, on the employer's own billing software.
On the credential side, payment posting sits inside AAPC's Certified Professional Biller (CPB) scope.
AAPC says the CPB covers claim submission for commercial payers, Medicare and Medicaid; coordination of benefits, medical necessity and prior authorization; denials, appeals, payment posting, reconciliation and collections; and HIPAA and fraud-and-abuse compliance.
That placement says something about the seat: posting is part of the biller's body of knowledge, and combined titles such as payment posting and accounts receivable specialist put the overlap in the job title itself.
What payment posters are paid
BLS has no separate code for medical billers — the closest available group is billing and posting clerks (SOC 43-3021), an all-industry occupation, not a medical-billing-specific one — and BLS put that group's median annual wage at $48,500 in May 2025.
For outlook, BLS projects the occupation essentially flat from 2025 to 2035, from 418,000 jobs in 2025 to 417,700 in 2035, with about 37,000 openings a year in its Employment Projections.
The direction is better inside health care: BLS expects employment to rise in fast-growing health care industries while automated invoice processing software raises productivity and limits overall growth, and it projects health care employment of these clerks up 6.6% by 2035.
For the full BLS tables behind this role, see the payment poster salary page.
Finding payment posting jobs
Search under every title the work hides behind: payment posting specialist, payment poster, cash poster, prompt payment posting specialist, and combined titles such as payment posting and accounts receivable specialist.
Read each posting for its own mix of keyed entry, auto-posting review and follow-up duties, and note the billing system it names.
Open payment poster jobs are listed here on MedicalBillingHires, a board that carries only medical billing and coding work.
Employers: if you are hiring posters, post a job on the board built for billing, coding and revenue-cycle roles.
This page is career information, not coding, billing-compliance, legal or tax advice. Confirm pay figures with BLS, and transaction or posting questions with the payer, your clearinghouse or the agency named.