Reimbursement Specialist

Ronald McDonald House Charities of Tampa Bay, Inc.•Tampa, FL

2d•Onsite

About The Position

At Ronald McDonald House Tampa Bay, every family stays completely free of charge so they can focus on what matters most - being close to their child during medical care. Making that possible requires a strong and sustainable mix of funding, including charitable support, grants, partnerships, and reimbursement programs. The Reimbursement Specialist plays a critical role in securing and maximizing these essential resources, ensuring eligible services are reimbursed accurately and timely while identifying new opportunities to strengthen revenue. This position is ideal for someone who understands that diligent follow-up, accurate documentation, and successful collections do more than support the bottom line - they help keep our doors open and our services free for every family who needs us.

Requirements

Associate degree in Business Administration, Healthcare Administration, Finance, Accounting, Public Administration, or a related field; equivalent relevant experience may be substituted.
Three years of progressively responsible experience in Medicaid billing, healthcare reimbursement, insurance claims administration, revenue cycle operations, accounts receivable, finance operations, government program administration, or a closely related area.
Proficiency with Microsoft Excel and Microsoft 365 applications.
Strong organizational, follow-up, and documentation skills.
Ability to manage multiple priorities, time-sensitive submissions, and deadlines with a high degree of accuracy.
Strong written and verbal communication skills.
Ability to work independently while collaborating effectively across departments and with external partners.
Ability to maintain confidentiality and appropriately handle sensitive family, financial, and reimbursement information.
Ability to remain seated or standing for extended periods and use standard office equipment and technology.
Ability to perform the essential functions of the position with or without reasonable accommodation.

Nice To Haves

Experience working with Florida Medicaid Managed Care Organizations (MCOs) (e.g., Sunshine Health, Simply Healthcare, Humana Healthy Horizons) and medical logistics/transportation brokers (e.g., Modivcare, Access2Care).
Experience with AHCA complaint processes, managed care grievances, claim appeals, and escalation management.
Experience coordinating statewide initiatives, coalitions, or external partnerships.
Nonprofit experience, preferably in healthcare, human services, or family-support organizations.
Analytical skills and the ability to identify reimbursement discrepancies, determine root causes, analyze financial and performance data, and translate findings into practical recommendations, forecasts, and actionable insights for organizational leadership.
Ability to develop, document, and consistently apply efficient workflows, procedures, and internal controls.

Responsibilities

Manage the complete reimbursement lifecycle for Medicaid lodging reimbursement programs.
Review referrals and stays for reimbursement eligibility.
Coordinate preauthorizations, authorization renewals, and required supporting documentation.
Submit accurate and timely reimbursement requests to approved payers and partners.
Monitor reimbursement status, payment activity, outstanding receivables, and aging trends; investigate denied, delayed, underpaid, or missing claims; and coordinate appeals, corrective action, and required follow-up.
Maintain reimbursement dashboards, aging reports, forecasts, complaint and grievance logs, resolution timelines, revenue trend analyses, and other performance reporting needed to identify barriers and support leadership decisions.
Monitor payer requirements and reimbursement process changes.
Monitor unresolved preauthorization and reimbursement requests.
Prepare, submit, document, and track AHCA complaints and grievances.
Maintain supporting evidence and case files for each escalation.
Coordinate communication with AHCA, managed care organizations, transportation brokers, and reimbursement partners.
Identify and pursue opportunities to maximize reimbursement revenue, reduce missed or delayed collections, expand participation in additional Medicaid managed care plans, and strengthen other reimbursement or revenue-generating initiatives that support organizational sustainability.
Analyze reimbursement trends and performance data.
Support leadership with reimbursement forecasting, planning, and reporting.
Assist with legislative, advocacy, and strategic initiatives related to Medicaid reimbursement.
Foster productive relationships with hospitals, managed care organizations, transportation brokers, government agencies, and partner organizations.
Support accounts payable, accounts receivable, cash receipt, vendor, and payment reconciliation activities.
Support financial recordkeeping, documentation management, and data verification.
Develop and maintain reports, dashboards, and performance metrics.
Cross-train on critical finance and operational functions to support business continuity during absences, transitions, or periods of increased workload.
Serve as a resource to internal departments requiring reimbursement, finance, reporting, or administrative support.
Develop, maintain, and share reimbursement standard operating procedures, forms, workflows, training materials, supporting files, and other process documentation to promote consistent practices within Ronald McDonald House Tampa Bay and across collaborating chapters.
Ensure reimbursement and related finance records are accurate, complete, secure, properly retained, and audit-ready in accordance with payer, state, contractual, and organizational requirements.
Support reimbursement, finance, and compliance audits or reviews.
Train internal stakeholders on reimbursement-related processes and documentation expectations.
Identify recurring payer issues, reimbursement barriers, root causes, and workflow inefficiencies; recommend and implement corrective actions and process improvements that strengthen reimbursement and Business Services operations.