Billing Stay Specialist

Description

Job Title: Billing Stay Specialist
Department: Operations
Reports To: Chief Operating Officer
Classification: Regular Full-Time, Hourly, Non-exempt

The Billing Specialist owns the third-party reimbursement cycle for family stays across all RMH Oregon Houses. The role secures, bills, and collects lodging reimbursement from Oregon Health Plan (OHP), other state Medicaid programs, Coordinated Care Organizations (CCOs) and Managed Care Organizations (MCOs), Non-Emergency Medical Transportation (NEMT) brokers, and private commercial insurance payers.

The Billing Specialist verifies eligibility, obtains prior authorizations, submits accurate claims, works aged receivables, resolves denials and appeals, and reconciles payments back to each House. Working closely with Family Placement and Guest Services, this role ensures every eligible stay is documented, compliant, and reimbursed.

Requirements

Eligibility and Prior Authorization

• Verify active Medicaid, OHP, MCO/CCO, or private insurance coverage at referral or check-in.
• Obtain lodging and travel prior authorizations for Medicaid NEMT brokers and payers before or at the start of each stay.
• Apply state and payer rules on travel-distance minimums and length-of-stay limits to determine lodging eligibility.
• Partner with Guest Services to gather required information and generate timely Arrival Notices.

Claims Preparation and Submission

• Compile required stay documentation, including hospital appointment verifications, night-stay logs, and check-in/check-out records.
• Review charges for accuracy and completeness and confirm all authorizations are valid before submission.
• Prepare and submit claim and invoice batches electronically according to state- and payer-specific requirements.
• Correctly bundle or separate claims for the pediatric patient and eligible parent or escort under EPSDT guidelines.

Accounts Receivable, Denials, and Appeals

• Monitor all third-party claims across the Chapter for approved, pending, and denied status.
• Manage aged third-party receivables and follow up on unpaid or denied claims through phone calls, payer portals, and written correspondence.
• Investigate denial reasons, correct and resubmit claims within filing limits, and identify trends to prevent recurring denials.
• Prepare and submit appeals for improperly denied or underpaid claims in accordance with payer guidelines and deadlines.

Reconciliation and Reporting

• Reconcile payments received and allocate reimbursements to the appropriate House.
• Maintain accurate records of all billing and collection activity within the Guest Management System.
• Generate and analyze reports on third-party billing, receivables, denials, and collection performance.

Compliance and Relationships

• Stay current on OHP, state Medicaid, and NEMT lodging reimbursement regulations and billing guidelines.
• Maintain organized, HIPAA-compliant files that are audit-ready for internal reviews and external audits.
• Build and maintain professional working relationships with OHP, MCO/CCO, NEMT broker, and private insurance representatives.
• Collaborate with Family Placement, Guest Services, and hospital social workers to resolve documentation and claim-related issues.
• Perform other duties as assigned.

Required Qualifications

• Two or more years of medical, Medicaid, or third-party billing and collections experience.
• Working knowledge of claim submission, denial management, and appeals processes.
• Understanding of HIPAA and the handling of protected health information (PHI).
• Strong attention to detail, organization, and ability to meet deadlines.
• Effective written and verbal communication skills with payers, care teams, families, and internal staff.
• Proficiency in Microsoft Office applications, particularly Excel, and experience using payer web portals.

Benefits Include

• Generous Paid Time Off: 144 hours of PTO annually, plus 12 paid holidays (10 standard holidays and 2 floating holidays).
• 100% Covered Healthcare: Medical and dental benefits fully paid for employees and their dependents.
• Retirement Savings: SIMPLE IRA with up to a 3% employer match.
• Annual volunteer hours to support community involvement.
• Employee Assistance Program (EAP).

Work Environment

• Primarily office-based computer and phone work; occasional travel between House locations and community event sites may be required.
• Ability to sit for extended periods and use a computer for the majority of the workday.
• Commitment to the mission of keeping families close to their hospitalized children.

Equal Opportunity Employer

Ronald McDonald House Oregon is an Equal Opportunity Employer. We are committed to fostering an inclusive environment for all employees and applicants, free from discrimination based on race, color, religion, sex, sexual orientation, gender identity or expression, national origin, age, disability, veteran status, genetic information, or any other status protected by federal, state, or local law.

This job description is not intended to be an employment agreement or contract. Management reserves the exclusive right to modify this job description at any time, with or without notice.