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San Antonio, Texas, United States
Onsite
Job Family:
PFS General
Travel Required:
Clearance Required:
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:
o Epic
o MEDITECH Magic
o MEDITECH 6.x / Expanse
· 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.
What You Will Need:
· Bachelor’s Degree & 5 Years of Relevant Experience OR High School Diploma/GED & 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+ 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 with the ability to manage competing priorities and deadlines.
· Ability to research and resolve payment discrepancies independently.
· Proficiency with Microsoft Excel and other standard business applications.
What Would Be Nice to Have:
· 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.
· 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
· Compliance with established procedures and internal controls
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What We Offer:
Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.
Benefits include:
Medical, Rx, Dental & 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 & Supplemental Life
Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts
Short-Term & Long-Term Disability
Tuition Reimbursement, Personal Development & Learning Opportunities
Skills Development & Certifications
Employee Referral Program
Corporate Sponsored Events & Community Outreach
Emergency Back-Up Childcare Program
About Guidehouse
Guidehouse is an Equal Opportunity Employer–Protected Veterans, Individuals with Disabilities or any other basis protected by law, ordinance, or regulation.
Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.
If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at 1-571-633-1711 or via email at RecruitingAccommodation@guidehouse.com. All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.
All communication regarding recruitment for a Guidehouse position will be sent from Guidehouse email domains including @guidehouse.com or guidehouse@myworkday.com. Correspondence received by an applicant from any other domain should be considered unauthorized and will not be honored by Guidehouse. Note that Guidehouse will never charge a fee or require a money transfer at any stage of the recruitment process and does not collect fees from educational institutions for participation in a recruitment event. Never provide your banking information to a third party purporting to need that information to proceed in the hiring process.
If any person or organization demands money related to a job opportunity with Guidehouse, please report the matter to Guidehouse’s Ethics Hotline. If you want to check the validity of correspondence you have received, please contact recruiting@guidehouse.com. Guidehouse is not responsible for losses incurred (monetary or otherwise) from an applicant’s dealings with unauthorized third parties.
Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.
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