Eligibility Specialist

This is a fully remote position, open to applicants in Florida.

📋 Description

• Verify the eligibility and benefits of patient insurance for new, returning, and existing patients within established departmental timelines.

• Review and address any insurance eligibility issues detected in WellSky and other relevant systems.

• Process and update changes in insurance, payer information, and associated demographic or coverage details.

• Accurately record eligibility and benefit information in patient files.

• Communicate any changes in eligibility, discrepancies, and coverage issues to branches and internal teams.

• Identify and escalate issues related to eligibility, coverage, or payers that may influence patient services, authorizations, billing, or reimbursement.

• Collaborate with the Eligibility Team Lead and Authorization Manager on complex eligibility issues and unresolved discrepancies.

• Engage with patients, insurance providers, payer representatives, branch staff, and internal departments to gather and clarify insurance information.

• Address eligibility-related inquiries and resolve concerns, discrepancies, and account-related issues.

• Maintain precise documentation of eligibility verification activities and communications.

• Monitor assigned accounts and follow up on pending eligibility matters.

• Achieve productivity, accuracy, quality, and turnaround-time goals.

• Participate in training sessions, staff meetings, quality initiatives, and process improvement activities.

• Perform other related tasks as assigned.

⛳️ Requirements

• A high school diploma or GED is required.

• At least one (1) year of experience in healthcare, medical billing, insurance verification, eligibility, or a related field is required.

• Preferred experience in verifying insurance eligibility and benefits.

• Preferred experience in home health or another healthcare environment.

• Preferred experience working with electronic medical records and payer portals.

• Previous experience with Medicare, Medicaid, managed care, commercial insurance, or other healthcare payer systems is preferred.

• Previous experience in home health is preferred.

• Familiarity with WellSky or similar healthcare information systems is preferred.

• Knowledge of insurance eligibility, benefits, deductibles, copayments, coinsurance, and coverage limitations is preferred.

• Ability to maintain confidentiality and adhere to HIPAA and all relevant privacy and security regulations.

• Adhere to Pinnacle Home Care policies, procedures, standards of conduct, attendance requirements, and relevant regulatory standards.

🏝️ Benefits

• Personalized, one-on-one care: Assist patients in healing and regaining their independence by providing tailored care in the comfort of their homes.

• Free Continuing Education Units (CEUs) to support licensure and career growth.

• Employee referral program that allows you to earn rewards.

• Flexible scheduling options.

• Supportive and collaborative team environment.

• Equal opportunity and inclusive workplace.