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.
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?
- 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!
Skills Required
- 3+ years of home health billing experience with hands-on DDE FISS
- Strong knowledge of PDGM billing, NOA rules, LUPA, PEP, outlier logic, condition/occurrence codes, revenue codes, TOBs 322/329
- Fluency with RTP research and correction in DDE, including HIQA/HIQH inquiry and claim history
- Experience with EDI transactions (837I, 835, 276/277) and familiarity with 270/271 eligibility checks
- Working knowledge of MACs (CGS, Palmetto, Noridian or equivalent) and major Managed Care payer portals
- Ability to reconcile remittances and post payments/adjustments from 835s and escalate variances/denials
- Experience tracking and resolving reason codes, edits, duplicates, overlap, and denial workflows
- Detail orientation, urgency, and consistent, clear written documentation on every account
What We Do
Pinnacle Home Care is a Florida-based, Medicare-certified home health provider serving senior patients in their homes. The company delivers skilled nursing, physical, occupational, and speech therapy, medical social work, home health aide support, behavioral health services, and patient education. Its mission is to help patients manage their health at home while preserving dignity, supporting families, and improving independence through compassionate care.
