Home Health Billing Professional

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 mostat home.

Pinnacle Home Care Floridas largest Medicare-certified home health provider has been delivering high-quality patient-centered care for over two decades and were looking for a Home Health Billing Professional to join our award-winning team.

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 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.

Qualifications

• 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.

Why Choose Pinnacle

• Growth & Stability: Over two decades as Floridas largest home health agency.
• Ongoing Professional Development: Free Continuing Education Units (CEUs) to support licensure and career advancement.
• Competitive Benefits & Perks: Including Daily Pay (work today get paid tomorrow!) and 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.

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 10000 patients across Florida every day.Apply now!

Required Experience:

Unclear Seniority