RCM Lead, Reconciliation & Cash Posting

About the Role

As an RCM Lead, Reconciliation & Cash Posting, you will own cash reconciliation at Nourish: ensuring we accurately report how much cash we have received from insurance and patients for services. You will keep Stripe and Candid aligned on total patient cash posted, work through unreconciled checks and ERAs, and oversee refund workflows for payers and patients.

You will build the SOPs and workflows for, and oversee, our team of virtual assistants (VAs) on reconciliation, and partner across MNT, new bets, and enterprise to support reconciliation for each of them. This is a high-ownership role where you will clear our unreconciled cash backlog and then become the Nourish expert for the areas you own.

This person will report into our Director of Collections, Riley Moore.

This role is full-time and open to NYC-based or remote employees.

Key Responsibilities:

• Own cash reconciliation end to end across patient and insurance payments, ensuring Stripe and Candid are aligned on total patient cash posted.
• Reconcile unreconciled checks and ERAs, tracing each item to root cause and closing it out.
• Size and sequence our unreconciled cash backlog, and build and execute a timeline to work it down.
• Onboard, direct, and oversee a team of VAs on reconciliation workflows, including work allocation, quality checks, and feedback.
• Build and maintain SOPs and workflows for VAs to manage unreconciled ERAs and cash.
• Oversee refund workflows for payers and patients, with controls in place to prevent incorrect or duplicate refunds.
• Partner across MNT, new bets, and enterprise to build and run reconciliation workflows for enterprise partners.
• Identify opportunities to optimize team workflows, including automation for reconciliation, and tackle improvements independently where you can.

We’d love to hear from you if:

• You have approximately 5–7 years of experience in cash posting and reconciliation.
• You have hands-on RCM cash reconciliation experience across both patient and insurance payments, including matching ERAs/EOBs and checks to deposits and working unreconciled items to resolution.
• You are comfortable with high-volume, process-driven, detail-heavy work and hold yourself to a high standard of accuracy.
• You have built new processes or SOPs from scratch, not just followed existing ones.
• You are a professional and empathetic written communicator who can write crisp SOPs and adjust your tone for patients, payers, and internal partners.
• You are scrappy and can break down ambiguous discrepancies across systems and solve them independently.
• You are flexible and adaptable in a fast-paced start-up environment with changing priorities, and you are low-ego and actively seek feedback.
• Bonus: experience managing, training, or directing others' work (ideally VAs or offshore teams), familiarity with Stripe, Candid, or comparable billing platforms and payer portals, startup or health-tech experience, or experience using automation or tooling to streamline reconciliation work. 

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