Cash Posting Supervisor - Hospital Revenue Cycle

Guidehouse Inc.; San Antonio (TX); On-site; USD 85,000 - 100,000; Full time

Job summary

Guidehouse Inc. in San Antonio, TX is seeking a Cash Posting Supervisor to oversee daily cash posting and payment reconciliation for hospital revenue cycle operations.

You will lead the Cash Posting team, monitor productivity, ensure deposits and batches are balanced, and resolve posting discrepancies across Epic and MEDITECH environments. The ideal candidate has hands-on cash posting and reconciliation experience, strong critical-thinking skills, and the ability to partner with Finance, Revenue

Qualifications

• Hands-on leader with strong cash posting and reconciliation experience.
• Experience with hospital patient accounting systems including Epic and MEDITECH.
• Ability to supervise cash posting staff and manage daily operations.

Responsibilities

• Oversee daily cash posting and payment reconciliation for hospital revenue cycle.
• Provide day-to-day leadership to the Cash Posting team and monitor productivity.
• Ensure deposits and payment batches are balanced; resolve posting discrepancies.
• Collaborate with Finance, Revenue Cycle, and other teams to address issues.
• Utilize Epic and MEDITECH environments in daily workflows.

Skills

Cash posting

Reconciliation

Leadership

Critical thinking

Tools

Epic

MEDITECH Magic

MEDITECH 6.x/Expanse

Job description

Job Family : PFS General

Travel Required : None

Clearance Required : None

This is a 100% On-Site role at our San Antonio, TX office. Schedule is Monday-Friday from 8AM-4:30PM.

What You Will Do:

The Cash Posting Supervisor is responsible for overseeing the daily cash posting and payment reconciliation functions for hospital and healthcare revenue cycle operations. This position ensures that patient and payer payments, adjustments, denials, and other financial transactions are posted accurately, timely, 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 daily deposits and payment activity are balanced and reconciled, resolves posting discrepancies, and partners with Revenue Cycle, Patient Financial Services, Finance, and other operational teams to address issues impacting cash reconciliation.

The ideal candidate is a hands-on leader with strong cash posting and reconciliation experience, excellent critical-thinking skills, and experience working within hospital patient accounting systems, including Epic, MEDITECH Magic, and MEDITECH 6.x/Expanse environments .

Essential Duties and Responsibilities

Cash Posting Operations

• 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 Electronic Remittance Advice (ERA), Electronic Funds Transfer (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 additional research or escalation.
• Ensure deposits and payment batches are processed according to established departmental procedures and deadlines.
• Identify opportunities to improve cash posting accuracy, efficiency, and automation.

Balancing and Reconciliation

• Oversee daily balancing of posted payments against bank deposits, remittance documentation, lockbox activity, and system totals.
• Perform and/or review daily, weekly, and monthly cash reconciliations.
• Investigate variances between bank deposits, payment files, and patient accounting system transactions.
• Ensure discrepancies are appropriately documented, researched, corrected, and escalated when necessary.
• Monitor outstanding reconciliation items and ensure timely resolution.
• Maintain appropriate documentation and audit trails supporting posted and reconciled transactions.
• Partner with Finance and Revenue Cycle leadership to resolve complex reconciliation issues.

Staff Management and Leadership

• 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 clear performance expectations and provide regular feedback to employees.
• 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 within the department.

Quality and Performance Management

• 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, or 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 consistently followed.

Critical Thinking and Problem Resolution

• 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 impact patient balances, payer balances, or financial reporting.

Systems and Technology

• Utilize hospital patient accounting and revenue cycle applications to manage cash posting and reconciliation activities.

Preferred experience with:

• Epic
• MEDITECH Magic
• MEDITECH 6.x / Expanse

Work with ERA/EFT files, lockbox platforms, payer portals, banking applications, and other revenue cycle technologies.

Assist with system testin