Billing Professional - Oldsmar, Florida, , United States
1 day ago
Job description
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 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, 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.
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 Florida's largest independent home health agency.
- Competitive Benefits & Perks: Including 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 10,000 patients across Florida every day. Apply now
Similar jobs
We are looking for a Home Health Billing Professional to join our award-winning team. · Pinnacle Home Care has been delivering high-quality, patient-centered care for over two decades. · ...
2 weeks ago
The Professional Billing (PB) Auditor – Surgical Specialty provides ongoing audit support for hospital-based physician billing with a focus on complex surgical services. · This role is responsible for auditing professional fee claims to ensure accurate coding regulatory complianc ...
1 month ago
+The Professional Billing (PB) Auditor – Surgical Specialty provides ongoing audit support for hospital-based physician billing with a focus on complex surgical services. · +Perform retrospective and/or concurrent audits of professional billing surgical claims · Review operative ...
1 month ago
The Professional Billing Coder – Cardiothoracic / Special Surgical is responsible for accurate and compliant coding of physician professional services for complex surgical procedures. · Assign accurate CPT, HCPCS, and ICD-10-CM codes for cardiothoracic and other special surgical ...
1 month ago
Job summaryThe Professional Billing (PB) Auditor – Surgical Specialty provides ongoing audit support for hospital-based physician billing with a focus on complex surgical services. ...
2 weeks ago
The Professional Billing Coder – Vascular Surgery is responsible for accurate coding of professional services related to vascular procedures. · ...
1 month ago
· Position Overview · The Professional Billing (PB) Auditor – Surgical Specialty provides ongoing audit support for hospital-based physician billing with a focus on complex surgical services. This role is responsible for auditing professional fee claims to ensure accurate coding ...
2 days ago
The Professional Billing Coder – Vascular Surgery is responsible for accurate coding of professional services related to vascular procedures. · This role supports compliant billing practices and contributes to revenue integrity and audit readiness. ...
1 month ago
The Professional Billing Coder – Cardiothoracic / Special Surgical is responsible for accurate and compliant coding of physician professional services for complex surgical procedures. · This role supports timely claim submission regulatory compliance revenue integrity within a ho ...
1 month ago
The Professional Billing (PB) Auditor – Surgical Specialty provides ongoing audit support for hospital-based physician billing with a focus on complex surgical services. · Perform retrospective and/or concurrent audits of professional billing surgical claims · Review operative re ...
1 month ago
We are seeking a Director of Billing & Collections to join our award-winning team. · The Director provides strategic leadership over all billing, accounts receivable, and collections functions for Pinnacle Home Care.Key Responsibilities: · Oversee all billing and collections acti ...
1 week ago
We are looking for a Medical Practice Manager to oversee daily operations in our outpatient healthcare medical practice. · Report directly to the Chief Medical Officer and CEO · Collaborate closely with care Providers (ARNPs and PAs) · ...
1 month ago
Join us in our mission of delivering compassionate healthcare where it matters most—at home. · ...
1 week ago
Filing completed documentation. Receiving, shipping, and purchasing functions in a manufacturing setting. · Filing completed documentation. · ...
2 weeks ago
We're seeking a highly organized and dedicated Dental Receptionist and Treatment/Insurance Coordinator to join our dynamic team. · - Provide warm and welcoming check-in and check-out experiences for patients · - Efficiently schedule appointments and manage the dental calendar · - ...
1 week ago
+Job summary · Pinnacle Home Care has been delivering high-quality patient-centered care for over two decades. · +Demonstrate strong organizational skills with the ability to effectively prioritize and execute all tasks related to the Revenue Cycle. · Collaborate with internal te ...
4 weeks ago
Occupational Therapist (OT) - Skilled Nursing Facility (SNF):FULL-TIME POSITION:This position is exclusively for professionals licensed in the state of Florida as a OT. All services are provided in a Skilled Nursing Facility (SNF).:Why Step Up Rehab?:We support clinicians with re ...
18 hours ago
Speech-Language Pathologist (SLP) - Skilled Nursing Facility (SNF)PRN POSITION **Increased rates when medical benefits are waived.**This position is exclusively for professionals licensed in the state of Florida as a SLP. All services are provided in a Skilled Nursing Facility (S ...
14 hours ago
Physical Therapist (PT) - Skilled Nursing Facility (SNF):PRN POSITION **Increased rates when medical benefits are waived.**:This position is exclusively for professionals licensed in the state of Florida as a PT. All services are provided in a Skilled Nursing Facility (SNF).:Why ...
14 hours ago
Speech-Language Pathologist (SLP) - Skilled Nursing Facility (SNF):FULL-TIME POSITION:This position is exclusively for professionals licensed in the state of Florida as a SLP. All services are provided in a Skilled Nursing Facility (SNF).:Why Step Up Rehab?:We support clinicians ...
14 hours ago