Cash Posting Supervisor | Hospital Revenue Cycle

Guidehouse • San Antonio, TX

6d • Onsite

About The Position

The Cash Posting Supervisor oversees daily cash posting and payment reconciliation for hospital and healthcare revenue cycle operations. The role ensures patient and payer payments, adjustments, denials, and other financial transactions are posted accurately and on time in accordance with established procedures and internal controls. The supervisor provides day-to-day leadership to the Cash Posting team, monitors productivity and quality, balances and reconciles deposits and payment activity, resolves posting discrepancies, and partners with Revenue Cycle, Patient Financial Services, Finance, and other teams to address cash reconciliation issues. The role uses hospital patient accounting systems and related payment technologies, supports system and workflow changes, and identifies opportunities to improve accuracy, efficiency, and automation. This is a 100% on-site position at the San Antonio, Texas office, scheduled Monday through Friday, 8:00 a.m. to 4:30 p.m.

Requirements

• Bachelor’s degree and 5 years of relevant experience, or high school diploma/GED and 9 years of relevant experience in lieu of higher education.
• 5 years of healthcare revenue cycle, hospital cash posting, payment posting, or related patient financial services experience.
• 2 or more years of supervisory or team-lead experience in healthcare revenue cycle operations.
• Prior experience with cash balancing and reconciliation.
• Demonstrated understanding of insurance and patient payment posting processes.
• Strong analytical, critical-thinking, and problem-solving abilities.
• Strong organizational skills and ability to manage competing priorities and deadlines.
• Ability to independently research and resolve payment discrepancies.
• Proficiency with Microsoft Excel and other standard business applications.

Nice To Haves

• Associate’s or bachelor’s degree in Business, Finance, Accounting, Healthcare Administration, or a related field.
• Hospital or multi-facility healthcare cash posting experience.
• Experience with Epic, MEDITECH Magic, and/or MEDITECH 6.x/Expanse.
• Experience managing high-volume cash posting operations.
• Knowledge of ERA/EFT, lockbox, electronic payment, and automated cash posting workflows.
• Strong knowledge of hospital cash posting and patient accounting workflows.
• Strong balancing and reconciliation skills.
• Understanding of third-party payer remittances and patient payments.
• Strong leadership and staff-management capabilities.
• Excellent written and verbal communication skills.
• Strong attention to detail and commitment to accuracy.
• Ability to analyze data and recognize trends or discrepancies.
• Ability to manage team productivity and quality standards.
• Ability to collaborate effectively with Revenue Cycle, Finance, Patient Financial Services, IT, and operational leadership.
• Ability to work successfully in a high-volume, deadline-driven environment.
• Demonstrated ability to maintain confidentiality and appropriately handle sensitive financial and patient information.

Responsibilities

• Supervise daily hospital cash posting activities involving insurance, patient, electronic, and manual payments.
• Ensure payments, contractual adjustments, denials, recoupments, refunds, and other transactions are posted accurately and timely.
• Monitor ERA, EFT, lockbox, credit card, and manual payment workflows.
• Research and resolve unapplied, unidentified, and misapplied cash; review posting exceptions and complex accounts for research or escalation.
• Ensure deposits and payment batches are processed according to departmental procedures and deadlines.
• Identify opportunities to improve cash posting accuracy, efficiency, and automation.
• Oversee daily balancing of posted payments against bank deposits, remittance documentation, lockbox activity, and system totals.
• Perform or review daily, weekly, and monthly cash reconciliations; investigate and resolve variances between deposits, payment files, and patient accounting transactions.
• Document, research, correct, and escalate discrepancies; monitor outstanding reconciliation items and maintain audit trails.
• Partner with Finance and Revenue Cycle leadership to resolve complex reconciliation issues.
• Supervise, coach, train, and develop Cash Posting staff; assign workloads and adjust staffing based on volumes, backlogs, and priorities.
• Monitor individual and team productivity, quality, attendance, and performance; set expectations and provide feedback.
• Conduct quality reviews, support onboarding and ongoing training, address performance concerns, and implement corrective action plans when appropriate.
• Promote accountability, teamwork, accuracy, and continuous improvement.
• Monitor cash posting, reconciliation, aging, and exception KPIs; prepare and communicate performance reports.
• Analyze trends and root causes of errors, reconciliation issues, and workflow delays; develop corrective action plans and work with leadership on benchmarks.
• Maintain current departmental procedures and ensure they are consistently followed.
• Analyze complex payment and reconciliation discrepancies, research issues across systems, facilities, payers, and bank transactions, and determine corrective actions.
• Identify recurring operational problems, recommend process improvements, and escalate financial, system, or compliance concerns appropriately.
• Use hospital patient accounting and revenue cycle applications, ERA/EFT files, lockbox platforms, payer portals, banking applications, and other revenue cycle technologies.
• Assist with system testing, upgrades, workflow changes, and implementation activities affecting cash posting; identify automation and workflow optimization opportunities.

Benefits

• Medical, prescription, dental, and vision insurance.
• Personal and family sick time and company-paid holidays.
• Position may be eligible for a discretionary variable incentive bonus.
• Parental leave.
• 401(k) retirement plan.
• Basic life and supplemental life insurance.
• Health Savings Account and dental/vision and dependent care Flexible Spending Accounts.
• Short-term and long-term disability.
• Tuition reimbursement, personal development, and learning opportunities.
• Skills development and certifications.
• Employee referral program.
• Corporate-sponsored events and community outreach.
• Emergency back-up childcare program.
• Flexible benefits package.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager