Billing Professional

Pinnacle Career • Oldsmar, FL

7d

About The Position

Are you looking to make a difference in patients’ lives with a company that values your expertise? Join us in our mission of delivering compassionate healthcare where it matters most –at home. Pinnacle Home Care, Florida’s largest independent Medicare-certified home health provider, has been delivering high-quality, patient-centered care for over two decades, and we’re looking for a Home Health Billing Professional to join our award-winning team.

Requirements

• 3+ years of home health billing experience with hands-on DDE FISS.
• Strong knowledge of PDGM billing, NOA rules, LUPA, PEP, outlier logic, condition and occurrence codes, revenue codes, and TOBs 322/329.
• Fluency with RTP research and correction in DDE - comfortable with HIQA/HIQH inquiry and claim history.
• Experience with EDI transactions: 837I, 835, 276/277.
• Working knowledge of MACs (CGS, Palmetto, Noridian or equivalent) and major Managed Care portals.
• Detail orientation, urgency, and pride in clean claim submission.
• Clear written documentation on every account touched.

Responsibilities

• Submit and manage Medicare home health claims in DDE FISS, including NOAs and final claims under PDGM.
• Work RTP, T, S, and R status queues daily - research, correct, and resubmit until paid.
• Verify eligibility and benefits using 270/271 or payer portals and resolve HETS eligibility mismatches.
• Track and resolve reason codes and edits (e.g., U532F, 38107, 34931, facility/provider edits, duplicate and overlap issues).
• Reconcile remittances and post payments and adjustments from 835s - escalate variances and denials.
• Manage Managed Care and commercial claims through payer portals and clearinghouses - correct and resubmit as needed.
• Partner with Clinical Intake, Coding, QA, and Clinical Ops to ensure billable readiness: signed orders, OASIS locked, visit notes complete, therapy thresholds if applicable, homebound and medical necessity documentation.
• Monitor and prevent late NOAs - document cause codes and request exceptions when appropriate.
• Work denials and ADRs - compile records, create index sheets, and submit timely responses.
• Maintain organized worklists, aging, and follow up notes with clear next actions.
• Protect PHI and follow CMS guidance, payer policies, and internal SOPs.

Benefits

• Growth & Stability : Over two decades as Florida’s largest independent home health agency.
• Competitive Benefits & Perks : Including an employee referral program where you can earn rewards.
• Recognized Excellence : Ranked as a USA Today Top Workplace.
• Supportive & Fun Culture : Join a collaborative, forward-thinking team that values both professional excellence and personal fulfillment.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed