Healthcare Accounting and Patient Revenue Reconciliation Training Course

Course overview

Healthcare finance teams must reconcile high volumes of patient charges, payments, contractual allowances, denials, refunds and bad-debt adjustments while maintaining an accurate general ledger and defensible revenue position. Breakdowns between patient accounting, billing, cash posting and finance can create unapplied cash, aged credit balances, misstated net patient service revenue and avoidable audit findings. This course equips participants to trace revenue from clinical charge capture through payer adjudication, patient responsibility, cash application and month-end reporting.

Participants learn to build a controlled patient revenue reconciliation process using source-system extracts, reconciliation workbooks, account mapping and exception logs. They examine gross charges, expected reimbursement, contractual adjustments, remittance advice transactions, payment variances, credit balances, refunds, write-offs and reserve movements. The course applies healthcare-specific accounting concepts including net patient service revenue, implicit price concessions, bad-debt treatment, revenue recognition under ASC 606 and Medicare cost-report considerations. Participants also develop practical methods for investigating variances between patient accounting subledgers, bank deposits, clearing accounts and the general ledger.

Instruction combines instructor-led walkthroughs with realistic hospital and ambulatory revenue-cycle cases, Excel-based reconciliation exercises, payer remittance analysis and group review of close controls. Participants leave with a completed patient revenue reconciliation pack containing a reconciliation template, account-mapping matrix, exception register, aging analysis, month-end checklist and corrective-action plan that can be adapted to their organisation's EHR, billing and ERP environment.

The programme is designed for experienced finance, revenue-cycle and accounting professionals who need to improve the accuracy, speed and auditability of patient revenue reporting. It is equally valuable for managers responsible for reducing unreconciled balances, strengthening close discipline and improving collaboration across finance and revenue-cycle operations.

Course objectives

By the end of this course, participants will be able to:

• Map patient charges, payments, adjustments and refunds from the patient accounting subledger to general ledger revenue and balance-sheet accounts
• Construct a monthly net patient service revenue reconciliation workbook with documented source extracts, control totals and sign-off fields
• Analyse ERA and EOB transactions to distinguish contractual allowances, denials, patient responsibility and payment variances
• Calculate expected reimbursement and investigate variances by payer, service line, location and claim status
• Reconcile cash receipts, lockbox deposits, merchant-card settlements and unapplied cash to bank and clearing accounts
• Evaluate credit balances, refund liabilities, write-offs and bad-debt movements using aging and exception-based review methods
• Apply ASC 606 principles to patient revenue recognition, variable consideration and implicit price concessions
• Produce a month-end reconciliation pack with exception logs, journal-entry support, ownership assignments and remediation actions

Benefits of attending

Target competencies

Who should attend

• Healthcare Accountants — who prepare revenue, receivable and allowance entries from patient accounting data
• Revenue Cycle Managers — who need to connect operational billing performance to reported patient revenue
• Patient Financial Services Managers — who oversee cash posting, credit balances, refunds and account-resolution teams
• Finance Managers and Controllers — who require reliable net patient service revenue and balance-sheet reconciliations
• Billing and Cash Posting Supervisors — who investigate remittance variances, unapplied cash and posting exceptions
• Internal Auditors and Compliance Analysts — who test revenue-cycle controls and require traceable reconciliation evidence

Requirements and prerequisites

Participants should have practical experience in healthcare finance, patient accounting, billing, cash posting or revenue-cycle operations. They should understand double-entry accounting, trial balances, accounts receivable, journal entries, accruals and basic Excel functions such as filters, SUMIFS, XLOOKUP or pivot tables. Familiarity with common revenue-cycle terms, including charges, claims, remittance advice, contractual adjustments, denials and patient responsibility, is assumed. Participants do not need to be expert users of Epic, Oracle Health, SAP or any particular EHR or ERP, and no coding, actuarial modelling or prior ASC 606 specialisation is required.

Training methodology

The instructor uses a simulated healthcare provider dataset containing charge extracts, claim-status reports, ERA transactions, cash-posting files, bank activity and general-ledger balances. Short technical sessions establish the accounting treatment and control objective, followed by guided Excel reconciliation builds and payer-variance investigations. Teams review realistic cases involving unapplied cash, credit balances, underpayments and late adjustments, then defend their proposed accounting treatment and escalation route. On the final day, each participant converts course outputs into a practical implementation plan for their own close cycle.

Course outline

Day 1: Healthcare patient revenue architecture

• Patient revenue lifecycle from charge capture to general ledger posting
• Healthcare chart of accounts for gross charges, allowances, receivables and cash
• Net patient service revenue versus gross patient charges
• Patient accounting subledger and general ledger control-account relationships
• Payer contracts, fee schedules and expected reimbursement concepts
• Claim adjudication terminology: ERA, EOB, CARC and RARC codes
• Revenue-cycle data lineage and reconciliation source-document hierarchy

Workshop: Participants map a sample hospital revenue flow and produce a source-to-ledger account-mapping matrix with identified control points.

Day 2: Revenue recognition and allowance reconciliation

• ASC 606 application to patient service revenue and variable consideration
• Implicit price concessions and the distinction from bad-debt expense
• Contractual allowance calculation by payer and service line
• Expected reimbursement models and estimated settlement adjustments
• Charge, payment and adjustment transaction-code mapping
• Reconciling gross charges and contractual adjustments to the revenue ledger
• Journal-entry support for revenue, allowance and receivable close entries

Workshop: Participants build a net patient service revenue bridge that reconciles patient accounting activity to revenue and allowance general-ledger accounts.

Day 3: Cash, remittances and accounts receivable

• ERA and EOB remittance file interpretation for payment posting
• Cash posting controls for insurer, patient, lockbox and card payments
• Bank deposit, merchant settlement and cash-clearing reconciliation
• Unapplied cash identification, aging and ownership assignment
• Accounts receivable aging by payer, financial class and claim status
• Underpayment and overpayment variance analysis against expected reimbursement
• Denial, appeal and recoupment transactions in receivables reconciliation

Workshop: Participants reconcile a payer remittance and bank deposit file to cash postings, identify unapplied items and prepare an exception register.

Day 4: Exceptions, reserves and balance-sheet risk

• Credit-balance aging and refund-liability review procedures
• Patient refunds, payer recoupments and escheatment considerations
• Bad-debt expense, collections activity and receivables reserve movements
• Medicare and Medicaid settlement receivables and payables
• Late charges, late payments and prior-period adjustment analysis
• Root-cause analysis for recurring posting and interface failures
• Segregation of duties and review controls for patient revenue reconciliations

Workshop: Participants assess a credit-balance and aged-receivables case, determine required accounting actions and produce a prioritized remediation log.

Day 5: Month-end close and reconciliation governance

• Designing a patient revenue month-end close calendar
• Reconciliation workbook structure, control totals and version control
• Materiality thresholds and risk-based exception escalation
• Preparing journal-entry evidence and reconciliation sign-off packages
• Management reporting for revenue, cash, receivables and allowance variances
• Audit trail requirements for source extracts, adjustments and reviewer evidence
• Continuous-improvement metrics for reconciliation timeliness and quality

Workshop: Participants complete a capstone month-end reconciliation pack and present a 90-day improvement plan for their patient revenue close process.

Tools & standards covered

Microsoft Excel, Epic Resolute, Oracle Health Patient Accounting, ASC 606

A typical training day

Live online deliveries follow the same structure in the East Africa Time zone, with shorter screen blocks and longer breaks.

What the fee includes

How you can take this course

Certification

Participants who complete the full five days receive the Skillset Development Certificate of Completion, stating the course title, course code, dates and delivery format — suitable for professional-development records and employer reimbursement.

Frequently asked questions