Health care finance leaders are focused on streamlining and improving the financial close.
Key takeaways
BlackLine can improve health care financial performance while enhancing patient outcomes.
BlackLine creates a foundation for sustainable growth, greater ROI and long-term value.
Middle market health care organizations are navigating rising expectations for faster closes, stronger controls and greater transparency, while balancing growing complexity across finance, operations and data. As margin pressures persist, finance leaders need to focus on streamlining reconciliations, reducing manual workloads and improving accuracy and compliance across the financial close.
In addition, labor constraints and demographic shifts are driving higher patient demand, leading to greater transaction volumes, claims activity and rework. To respond effectively, organizations should standardize processes and adopt technology-enabled solutions that improve consistency and control while optimizing return on investment.
BlackLine, a cloud-based agentic financial operations platform, supports these efforts by helping improve financial performance across the health care landscape, while enhancing patient outcomes. Without a structured approach, fragmented processes and inconsistent workflows will continue to limit efficiency, increase risk and constrain visibility across the close cycle.
Maximizing the value of BlackLine
View RSM’s latest webinar, "Financial close automation in health care accounting with BlackLine," to learn practical guidelines for enhancing auditability in the financial close process while reducing manual workflows.
The evolving role of finance leaders
Technology adoption is accelerating, raising expectations for finance teams to deliver a faster close, stronger controls and greater visibility. At the same time, growing complexity across health care operations, finance and data is increasing risk and compliance issues.
Key trends include:
Cybersecurity and data privacy
The volume and sensitivity of patient data are rising, increasing exposure to cybersecurity and privacy risks.
Industry consolidation and partnerships
Organizations are consolidating and restructuring to gain scale and negotiating leverage, while technological advancements are driving innovation and strategic partnerships.
Changing demands for care delivery
Patient expectations are evolving, increasing demand for better access, improved experiences and greater overall value.
Expanding risk boundaries
Growth, regulatory demands and new care models are expanding risk beyond a single organization’s boundaries.
Digital transformation
Data volumes are expanding and fragmenting, accelerating the adoption of artificial intelligence, analytics and cloud solutions to support scalability and insight.
Margin pressures
Rising costs, reimbursement constraints, supply chain disruptions, labor shortages and legacy systems are putting pressure on margins.
At the start of 2026, the U.S. Bureau of Labor Statistics reported an average of 50,000 new health care jobs added per month. Despite this growth, demand for nurses and senior care workers continues to outpace supply. In addition, more than 11,000 Americans turn 65 each day, increasing interaction with the health care system.
These trends are increasing patient demand and driving higher transaction volumes, claims complexity, denials and rework, placing additional strain on existing resources across urban, suburban and rural settings.
As a result, the financial close can no longer rely on heroics and manual effort. Standardization and automation are essential to improve consistency and efficiency. The goal is to reduce manual effort, improve control and enable teams to focus on higher-value activities such as exception handling and decision support.
Technology is no longer just an efficiency play. It also helps optimize recruiting, retention and risk mitigation, while scaling operations.
In addition, given that health care margins are already thin—around 2%—investments should be deliberate to maximize ROI. Organizations should plan their investments to bridge labor gaps, support margin improvement, enhance supply chain visibility, and align people, processes and technology.
Challenges and solutions
Finance and accounting teams often face operational and data issues that complicate the close process and limit efficiency, leading to delays, rework and increased risk, while limiting time for value-added analysis. Key issues include:
High transaction volumes: Large volumes of patient charges, adjustments and reimbursements increase reconciliation workload.
Resource and visibility constraints: Lean accounting teams and limited real-time insight into reconciliation status, risks and bottlenecks constrain performance.
Operational and financial complexity: Manual, inconsistent close activities across departments and care locations create delays and rework.
Data fragmentation across systems: Financial data spread across electronic health records, billing, claims and enterprise resource planning (ERP) systems makes consolidation difficult.
Regulatory and compliance pressure: Strict audit, Health Insurance Portability and Accountability Act (HIPAA) and documentation requirements demand accurate, well-controlled financial processes.
Health care organizations need more than point solutions or spreadsheets to address these challenges. BlackLine enables future-ready financial operations through unified data and optimized workflows, supported by automation and real-time insight.
BlackLine’s interconnected, modular platform spans the full close cycle, automating high-volume tasks to streamline operations and improve auditability. Common pain points and solutions include:
Transaction matching
- Pain point: Manual reconciliations involve complex, high-volume activity, creating time-consuming work and increasing errors.
- Solution: BlackLine Transaction Matching automates high-volume reconciliations with configurable rules to accurately pair transactions, reducing manual effort and allowing accountants to focus on exceptions.
Journal entry management
- Pain point: Manual journal entries at high volumes create ongoing, repetitive work, increasing effort and the risk of errors.
- Solution: BlackLine Journal Entry automates recurring entries using built-in workflows and approvals, improving accuracy and supporting compliance.
Compliance
- Pain point: Lengthy audits often uncover issues caused by manual processes and inconsistent data, driving audit challenges.
- Solution: BlackLine centralizes financial data across entities, providing real-time visibility with attached documentation and audit-ready detail.
Account reconciliations
- Pain point: The financial close is resource-intensive and relies heavily on manual effort, limiting time for strategic analysis.
- Solution: BlackLine automates journal posting and reconciliation certification, reducing manual work and improving efficiency.
- Pain point: Manual reconciliations involve complex, high-volume activity, creating time-consuming work and increasing errors.
- Solution: BlackLine Transaction Matching automates high-volume reconciliations with configurable rules to accurately pair transactions, reducing manual effort and allowing accountants to focus on exceptions.
- Pain point: Manual journal entries at high volumes create ongoing, repetitive work, increasing effort and the risk of errors.
- Solution: BlackLine Journal Entry automates recurring entries using built-in workflows and approvals, improving accuracy and supporting compliance.
- Pain point: Lengthy audits often uncover issues caused by manual processes and inconsistent data, driving audit challenges.
- Solution: BlackLine centralizes financial data across entities, providing real-time visibility with attached documentation and audit-ready detail.
- Pain point: The financial close is resource-intensive and relies heavily on manual effort, limiting time for strategic analysis.
- Solution: BlackLine automates journal posting and reconciliation certification, reducing manual work and improving efficiency.
In addition, BlackLine delivers strong ROI, with an average return of $2.77 for every dollar invested and approximately 2.6 times more work performed with existing head count, along with a 99.9% transaction match rate and a 70% faster close process.
Practical use cases
BlackLine provides an array of potential use cases to help organizations transition from reactive to proactive management by increasing focus on analysis, improving ROI and enabling early risk detection. Use cases include:
Electronic medical record (EMR) to billing reconciliation
Issue
Data is often manually pulled from multiple systems—such as banks, EMRs, billing platforms and ERPs—and further processed in spreadsheets, where teams spend significant time manipulating data, performing lookups, matching and resolving timing differences. This manual effort increases delays, errors and leakage through write-offs, missed follow-ups and higher risk over time.
Solution
BlackLine centralizes data from multiple sources into a single controlled environment using secure file transfers, APIs or prebuilt connectors, reducing manual extraction and enabling automation. It standardizes and validates data, improving control, auditability and efficiency across reconciliations and journal entries.
For cash account reconciliations and EMR matching, BlackLine automates high-volume reconciliations, such as matching bank transactions to EMR patient records and linking EMR activity to the general ledger (GL). Data from multiple sources is streamlined and processed using configurable, rule-based matching logic, handling one-to-one, one-to-many and many-to-many matches, along with timing thresholds.
Benefits
BlackLine’s match rate of more than 85% enables teams to focus on the remaining 15% exceptions, reducing manual effort while improving accuracy and maintaining a complete, reliable GL.
Data is often manually pulled from multiple systems—such as banks, EMRs, billing platforms and ERPs—and further processed in spreadsheets, where teams spend significant time manipulating data, performing lookups, matching and resolving timing differences. This manual effort increases delays, errors and leakage through write-offs, missed follow-ups and higher risk over time.
BlackLine centralizes data from multiple sources into a single controlled environment using secure file transfers, APIs or prebuilt connectors, reducing manual extraction and enabling automation. It standardizes and validates data, improving control, auditability and efficiency across reconciliations and journal entries.
For cash account reconciliations and EMR matching, BlackLine automates high-volume reconciliations, such as matching bank transactions to EMR patient records and linking EMR activity to the general ledger (GL). Data from multiple sources is streamlined and processed using configurable, rule-based matching logic, handling one-to-one, one-to-many and many-to-many matches, along with timing thresholds.
BlackLine’s match rate of more than 85% enables teams to focus on the remaining 15% exceptions, reducing manual effort while improving accuracy and maintaining a complete, reliable GL.
Pre-consolidation analysis
Issue
Consolidation becomes difficult when activity occurs across the organization at different times. With fragmented data and inconsistent processes, teams struggle to produce accurate financial statements quickly, increasing the risk of inaccuracies and affecting strategic decision making. It also reduces productivity by shifting skilled teams from analysis to manual data consolidation.
Solution
BlackLine Financial Reporting Analytics (FRA) ingests data from multiple sources and helps increase the quality of reconciliations while aggregating GL balances into financial statements, using account mappings. In addition, it provides a preclose view of financial results, improves data quality and is especially useful for multi-ERP or acquisitive organizations. FRA allows earlier insights into variances, generates an audit trail, enables configurable flux analysis and reduces manual effort through a largely automated, low-touch process.
Benefits
BlackLine leverages generative AI to summarize and surface material variances for review, enabling human-in-the-loop validation while highlighting key financial statement movements, based on underlying data, reconciliations and flux explanations.
Consolidation becomes difficult when activity occurs across the organization at different times. With fragmented data and inconsistent processes, teams struggle to produce accurate financial statements quickly, increasing the risk of inaccuracies and affecting strategic decision making. It also reduces productivity by shifting skilled teams from analysis to manual data consolidation.
BlackLine Financial Reporting Analytics (FRA) ingests data from multiple sources and helps increase the quality of reconciliations while aggregating GL balances into financial statements, using account mappings. In addition, it provides a preclose view of financial results, improves data quality and is especially useful for multi-ERP or acquisitive organizations. FRA allows earlier insights into variances, generates an audit trail, enables configurable flux analysis and reduces manual effort through a largely automated, low-touch process.
BlackLine leverages generative AI to summarize and surface material variances for review, enabling human-in-the-loop validation while highlighting key financial statement movements, based on underlying data, reconciliations and flux explanations.
The takeaway: A roadmap for scalable finance automation
Finance automation is a journey and not a one-time implementation. Health care organizations often make the mistake of automating only visible pain points without addressing underlying root causes, limiting overall value. Instead, a more effective approach starts with a structured plan that identifies high-impact areas for automation, establishes a phased roadmap and evaluates integration and support needs before moving into execution.
Success depends on targeting key close bottlenecks first and scaling over time, supported by strong change management and continuous optimization. BlackLine helps establish a foundation for sustainable growth while delivering greater ROI and long-term value. As these digital solutions continue to evolve, finance and accounting leaders increasingly look beyond their organizations to fully determine which modules best align with their finance automation goals.
Ready to get started? RSM’s finance automation team brings experience in AI-enabled automation within BlackLine to enhance accuracy, compliance and auditability across the financial close. Contact our team to learn how you can close faster, reduce risk and improve efficiency without adding complexity.
Frequently asked questions
Organizations should start with high-impact matching, reconciliations and tasks modules and expand into journals and analytics, building a roadmap for sustained automation and control improvements.
BlackLine can speed the close process, reduce unapplied cash, decrease audit hours, reduce the manual workload, increase auto-certification rates for reconciliations and expand team capacity without adding head count.
Close automation implementation should focus on analyzing current pain points, prioritizing high-impact areas, standardizing processes, defining integration needs and building a phased roadmap. Effective implementation is important to establish governance, reporting and maintenance models.
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