Reimbursement Specialist
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.
Employment Overview:
Mission Statement:
At Ronald McDonald House Tampa Bay, we provide essential services that remove barriers, strengthen families and promote healing when children need healthcare.
Organization:
Ronald McDonald House Tampa Bay has been working to improve the health and well-being of children and their families since 1980. Our primary program, the Ronald McDonald House, provides a place to stay for families that have children receiving medical treatment at Tampa Bay hospitals and outpatient centers. There are 5 Ronald McDonald Houses in Tampa Bay, 3 located in St. Petersburg and 2 located in Tampa.
Position Overview:
The Reimbursement Specialist serves as Ronald McDonald House Tampa Bay's primary administrator and subject matter resource for Medicaid and other reimbursement programs. The position maximizes reimbursement revenue by managing eligibility reviews, preauthorization's, submissions, payment tracking, collections, denials, grievances, compliance, documentation, reporting, and process improvement. The role collaborates with healthcare providers, managed care organizations, transportation brokers, state agencies, and Ronald McDonald House chapters throughout Florida to expand reimbursement opportunities and cross-trains on key finance and business functions to support operational continuity. As organizational initiatives grow, this role may expand to encompass commercial and private health insurance reimbursement opportunities.
Schedule Flexibility: This position may be structured as either a full-time, benefited role working 40 hours per week or a reduced-schedule, part-time role working 30-35 hours per week. We welcome qualified candidates seeking either arrangement and will determine the final schedule collaboratively based on the selected candidate's availability and organizational needs. The position maintains a consistent Monday-Friday schedule during regular business hours.
Medicaid Reimbursement Administration:
AHCA Complaints, Grievances & Escalation Management:
Strategic Revenue Support:
Business Services Support & Operational Redundancy:
Compliance & Documentation:
JOB QUALIFICATIONS:
Required Knowledge/Experience:
Skills and Abilities Required:
PLEASE NOTE: Management reserves the right to change or otherwise modify the functions of this job to meet the needs of the company. Additional duties may also be assigned. Consideration will be given to make reasonable accommodations for individuals with disabilities. The probationary period is 90 days. A review will be conducted by the direct supervisor at 90 days and 1 year; yearly review thereafter with salary consideration.
The successful candidate will be required to meet our pre-employment background screening requirements.
Employment Overview:
- Reports to: Senior Accounting Manager
- Classification: Full Time, Salary - Exempt. Part Time Option Available.
- Benefits: 100% Employer Covered Medical, Dental, & Life Insurance. Options: Vision, Short Term Disability, and other Voluntary Benefits. 401(k) eligibility after 90 days.
- Work Location: Tampa House- Business Office - 35 Columbia Dr, Tampa, FL 33606. Must have the ability to travel to our Tampa/St. Pete locations as needed.
- Schedule: 40 hours a week, typically between 9:00am - 5:00pm Monday - Friday
- Pay: $50,000 per year minimum - based on experience
Mission Statement:
At Ronald McDonald House Tampa Bay, we provide essential services that remove barriers, strengthen families and promote healing when children need healthcare.
Organization:
Ronald McDonald House Tampa Bay has been working to improve the health and well-being of children and their families since 1980. Our primary program, the Ronald McDonald House, provides a place to stay for families that have children receiving medical treatment at Tampa Bay hospitals and outpatient centers. There are 5 Ronald McDonald Houses in Tampa Bay, 3 located in St. Petersburg and 2 located in Tampa.
Position Overview:
The Reimbursement Specialist serves as Ronald McDonald House Tampa Bay's primary administrator and subject matter resource for Medicaid and other reimbursement programs. The position maximizes reimbursement revenue by managing eligibility reviews, preauthorization's, submissions, payment tracking, collections, denials, grievances, compliance, documentation, reporting, and process improvement. The role collaborates with healthcare providers, managed care organizations, transportation brokers, state agencies, and Ronald McDonald House chapters throughout Florida to expand reimbursement opportunities and cross-trains on key finance and business functions to support operational continuity. As organizational initiatives grow, this role may expand to encompass commercial and private health insurance reimbursement opportunities.
Schedule Flexibility: This position may be structured as either a full-time, benefited role working 40 hours per week or a reduced-schedule, part-time role working 30-35 hours per week. We welcome qualified candidates seeking either arrangement and will determine the final schedule collaboratively based on the selected candidate's availability and organizational needs. The position maintains a consistent Monday-Friday schedule during regular business hours.
Medicaid Reimbursement Administration:
- Maintain compliance with applicable legal and regulatory requirements for nonprofit finance, including restricted funds and grant tracking aligned with donor intent.
- Utilize and maintain organizational financial and administrative systems with accuracy and consistency; identify and escalate system issues or improvement opportunities to leadership.
- Perform other related duties as assigned in support of the organization's financial and business operations.
- 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.
AHCA Complaints, Grievances & Escalation Management:
- 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.
Strategic Revenue Support:
- 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.
Business Services Support & Operational Redundancy:
- 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.
Compliance & Documentation:
- 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.
JOB QUALIFICATIONS:
Required Knowledge/Experience:
- 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.
- 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.
Skills and Abilities Required:
- 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.
- 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.
PLEASE NOTE: Management reserves the right to change or otherwise modify the functions of this job to meet the needs of the company. Additional duties may also be assigned. Consideration will be given to make reasonable accommodations for individuals with disabilities. The probationary period is 90 days. A review will be conducted by the direct supervisor at 90 days and 1 year; yearly review thereafter with salary consideration.
The successful candidate will be required to meet our pre-employment background screening requirements.