Healthcare Eligibility Specialist

🔥 19 minutes ago

🐊 Florida – Remote

🐊 Florida – Remote

⏱ Part 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. • Review and resolve insurance eligibility issues in WellSky and other applicable systems. • Process and update insurance changes, payer information, and demographic or coverage information. • Document coverage dates, insurance details, copayments, deductibles, coinsurance, limitations, requirements, and out-of-network considerations. • Communicate eligibility changes, discrepancies, and coverage concerns to branches and internal departments. • Identify and escalate issues affecting patient services, authorizations, billing, or reimbursement. • Collaborate with the Eligibility Team Lead and Authorization Manager on complex eligibility matters and payer requirements. • Communicate with patients, insurance companies, payer representatives, branch personnel, and internal departments. • Respond to eligibility-related inquiries and resolve discrepancies or account issues. • Maintain complete eligibility verification documentation and monitor assigned accounts. • Meet productivity, accuracy, quality, and turnaround-time expectations. • Protect confidential patient information and comply with HIPAA and applicable regulations. • Participate in training, staff meetings, quality initiatives, and process-improvement activities.

🎯 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. • Ability to work Saturdays and Sundays in 8-hour shifts from 8:30 AM–5:00 PM Eastern Time, with a Monday start. • Ability to comply with HIPAA, privacy, security, regulatory, attendance, and company 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.