Eligibility Specialist

🔥 5 minutes ago

🐊 Florida – Remote

🐊 Florida – Remote

⏰ Full Time

🟢 Junior

🚫👨‍🎓 No degree required

👻 Ghost score 10%

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Pinnacle Home Care

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2003

🏥 Healthcare

👥 B2C

Healthcare • B2C

Pinnacle Home Care is a Florida-based home healthcare provider that delivers a broad range of in-home clinical services. Since 2003 the company has grown into the largest independent home health provider in Florida, serving over 310,000 patients to date and caring for more than 10,000 patients daily. Pinnacle provides skilled nursing, physical/occupational/speech therapy, medical social work, behavioral health, remote patient monitoring (through a RemoteFocus partnership), and specialty post-acute services including cardiac, pulmonary, neurological, diabetic, surgical, urological, and wound care — all focused on preventing readmissions and supporting patients’ independence at home.

📋 Description

• Verify patient insurance eligibility and benefits for new, returning, and existing patients within established departmental timeframes. • Review and resolve insurance eligibility issues identified in WellSky and other applicable systems. • Process and update insurance changes, payer information, and related demographic or coverage information. • Accurately document eligibility and benefit information in patient records. • Communicate eligibility changes, discrepancies, and coverage concerns to branches and internal departments. • Identify and escalate eligibility, coverage, or payer-related issues affecting patient services, authorizations, billing, or reimbursement. • Collaborate with the Eligibility Team Lead and Authorization Manager on complex eligibility matters and unresolved discrepancies. • Communicate with patients, insurance companies, payer representatives, branch personnel, and internal departments to obtain and clarify insurance information. • Respond to eligibility-related inquiries and resolve concerns, discrepancies, and account issues. • Maintain accurate documentation of eligibility verification activities and communications. • Monitor assigned accounts and follow up on outstanding eligibility issues. • Meet productivity, accuracy, quality, and turnaround-time expectations. • Participate in training, staff meetings, quality initiatives, and process-improvement activities. • Perform other related duties as assigned.

🎯 Requirements

• High school diploma or GED required. • Minimum of one (1) year of healthcare, medical billing, insurance verification, eligibility, or related experience required. • Experience verifying insurance eligibility and benefits preferred. • Experience in home health or another healthcare setting preferred. • Experience working with electronic medical records and payer portals preferred. • Previous experience with Medicare, Medicaid, managed care, commercial insurance, or other healthcare payer systems preferred. • Previous home health experience preferred. • Experience with WellSky or similar healthcare information systems preferred. • Knowledge of insurance eligibility, benefits, deductibles, copayments, coinsurance, and coverage limitations preferred. • Maintain confidentiality and comply with HIPAA and all applicable privacy and security requirements. • Follow Pinnacle Home Care policies, procedures, standards of conduct, attendance requirements, and applicable regulatory requirements.

🏖️ Benefits

• Personalized, One-on-One Care: Help patients heal and regain their independence by delivering individualized care in the comfort of their homes. • Free Continuing Education Units (CEUs) to support licensure and career advancement. • Employee referral program where you can earn rewards. • Flexible Scheduling. • Supportive and collaborative team culture. • Equal opportunity and inclusive workplace.