Home Health Billing Specialist

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 Reimbursement Analyst to join our award-winning team. Qualifications:

• 3+ years of home health billing experience with hands-on DDE FISS (must be visible on resume submitted).
• Experience with Medicare home health billing, including claim submission and reimbursement processes.
• Experience researching and resolving claim denials.
• Experience managing full revenue cycle billing functions.
• 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.

Key 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.

Why Choose Pinnacle?

• Personalized, One-on-One Care: Help patients heal and regain their independence by delivering individualized care in the comfort of their homes.
• Growth & Stability: Over two decades as Florida’s largest independent home health agency.
• 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.
• Recognized Excellence: Ranked as a USA Today Top Workplace.
• Flexible Scheduling: Enjoy a schedule that aligns with your personal priorities.
• Supportive & Fun Culture: Join a collaborative, forward-thinking team that values both professional excellence and personal fulfillment.

Pinnacle promotes an inclusive environment and is an equal opportunity employer. We prohibit discrimination or harassment based on race, religion, age, gender, national origin, disability, veteran status, or other legally protected characteristics. Be part of a company that empowers clinicians to make a difference in the lives of over 10,000 patients across Florida every day. Apply now! About Pinnacle Home Care Inc.: Pinnacle has 16 locations throughout Florida hiring for Healthcare Sales Professionals, Clinical Managers, RNs, LPNs, PTs, PTAs, SLPs, OTs, OTAs and other Healthcare positions. If you don't see a role that meets your skill set on the job board, send us your resume directly to [email protected] Please include your full name and location! We look forward to assisting you in exploring career opportunities with Pinnacle Home Care! About Us: Pinnacle Home Care, the largest independent home healthcare provider in Florida, has proudly served our communities for over two decades. We are a team driven by a passion for home healthcare with an unwavering commitment to the well-being of our patients and their families. At Pinnacle, we foster a forward-thinking, collaborative workplace culture. This has earned us multiple recognitions including the Top Workplaces USA award – a testament to our focus on supporting and empowering our employees. We offer a comprehensive suite of services, including skilled nursing, physical therapy, occupational therapy, speech therapy, medical social work and home health aide support to more than 10,000 patients across our service areas. We strive to help seniors thrive, not only under our care, but long after our services are complete. At Pinnacle, we are proud to make a meaningful difference in the lives of patients and their families every day. Join us in our mission to deliver compassionate healthcare where it matters most – at home. Apply To This Job