Billing Specialist

Pinnacle Home Care • Oldsmar, FL

53d

About The Position

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 Reimbursement Analyst to join our award-winning team. We are looking for a Billing Specialist to join our team. This role is crucial in ensuring that our patients receive the care they need by managing the billing process effectively. We are committed to delivering compassionate healthcare where it matters most – at home.

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

• Ongoing Professional Development: Free Continuing Education Units (CEUs) to support licensure and career advancement.
• Competitive Benefits & Perks: Including an employee referral program where you can earn rewards.
• Flexible Scheduling: Enjoy a schedule that aligns with your personal priorities.

What This Job Offers

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