Cash Posting Supervisor | Hospital Revenue Cycle

Guidehouse • San Antonio, TX

7d • 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, promptly, and in accordance with established policies, procedures, and internal controls.

The supervisor provides day-to-day leadership to the Cash Posting team, monitors productivity and quality, ensures deposits and payment activity are balanced and reconciled, resolves posting discrepancies, and partners with Revenue Cycle, Patient Financial Services, Finance, and other operational teams on cash reconciliation issues. The role uses hospital patient accounting and revenue cycle applications and may assist with system testing, upgrades, workflow changes, and implementation activities affecting cash posting. Epic, MEDITECH Magic, and MEDITECH 6.x/Expanse experience is preferred.

This is a 100% on-site role at the company’s San Antonio, Texas office, scheduled Monday through Friday from 8:00 a.m. to 4:30 p.m. Travel is not required.

Requirements

• Bachelor’s degree and 5 years of relevant experience, or a 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 research and resolve payment discrepancies independently.
• 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 productivity and quality standards across a team.
• 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.
• The posting lists cash posting timeliness, posting accuracy and quality, daily cash reconciliation accuracy, outstanding/unapplied cash levels, exception and variance resolution, team productivity, employee quality performance, backlog management, timely escalation and resolution of operational issues, and compliance with procedures and internal controls as areas of focus.

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 promptly.
• Monitor ERA, EFT, lockbox, credit card, and manual payment workflows.
• Ensure unapplied, unidentified, and misapplied cash is researched and resolved promptly.
• Review posting exceptions and complex accounts requiring 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 variances between bank deposits, payment files, and patient accounting system transactions.
• Ensure discrepancies are documented, researched, corrected, and escalated when necessary.
• Monitor outstanding reconciliation items and ensure timely resolution.
• Maintain documentation and audit trails supporting posted and reconciled transactions.
• Partner with Finance and Revenue Cycle leadership to resolve complex reconciliation issues.
• Provide direct supervision, coaching, training, and development for Cash Posting staff.
• Assign daily workloads and adjust staffing based on payment volumes, backlogs, and operational priorities.
• Monitor individual and team productivity, quality, attendance, and performance.
• Establish performance expectations and provide regular employee feedback.
• Conduct quality reviews to identify errors, process gaps, and training opportunities.
• Support onboarding and ongoing training of new and existing employees.
• Address performance concerns and implement corrective action plans when appropriate.
• Promote accountability, teamwork, accuracy, and continuous improvement.
• Monitor key performance indicators related to cash posting productivity, accuracy, reconciliation, aging, and outstanding exceptions.
• Prepare and communicate daily, weekly, and monthly performance reports.
• Analyze trends and identify root causes of posting errors, reconciliation issues, and workflow delays.
• Develop corrective action plans when performance or quality falls below established standards.
• Work with leadership to establish productivity and quality benchmarks.
• Ensure departmental procedures remain current and are consistently followed.
• Analyze complex payment and reconciliation discrepancies and determine appropriate corrective action.
• Research payment issues across multiple systems, facilities, payers, and bank transactions.
• Identify recurring operational problems and recommend sustainable process improvements.
• Escalate financial, system, or compliance concerns appropriately.
• Exercise sound judgment when resolving exceptions that could affect patient balances, payer balances, or financial reporting.
• Use hospital patient accounting and revenue cycle applications to manage cash posting and reconciliation activities.
• Work with 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 opportunities for automation and workflow optimization.

Benefits

• Medical, prescription, dental, and vision insurance
• Personal and family sick time
• 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
• 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

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Education Level: High school or GED