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 an Eligibility Specialist to join our award-winning team. Key Responsibilities 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 as required. Accurately document eligibility and benefit information in the patient record, including, when applicable: Effective and termination dates of coverage, primary and secondary insurance information, copayments and deductibles, coinsurance, benefit limitations, coverage requirements, out-of-network considerations, other payer-specific requirements that may affect services or reimbursement. Communicate eligibility changes, discrepancies, or coverage concerns to the appropriate branch and internal departments in a timely manner. Identify potential eligibility, coverage, or payer-related issues that could affect patient services, authorizations, billing, or reimbursement and escalate them. Collaborate with the Eligibility Team Lead and Authorization Manager regarding complex eligibility matters, unresolved discrepancies, payer requirements, and issues requiring escalation. Communicate professionally and effectively with patients, insurance companies, payer representatives, branch personnel, and internal departments to obtain and clarify insurance information. Respond to eligibility-related inquiries and work toward timely resolution of identified concerns, discrepancies, or account issues. Maintain accurate and complete documentation of eligibility verification activities and communications in the appropriate systems. Meet established productivity, accuracy, quality, and turnaround-time expectations for the position. Monitor assigned accounts and follow up on outstanding eligibility issues within established departmental timeframes. Maintain confidentiality and comply with HIPAA and all applicable privacy and security requirements when handling protected health information. Follow Pinnacle Home Care policies, procedures, standards of conduct, attendance requirements, and applicable regulatory requirements. Participate in training, staff meetings, quality initiatives, and process-improvement activities as assigned. Perform other related duties and responsibilities as assigned by the Eligibility Team. Lead, Authorization Manager, or other authorized member of management accountability and Performance Expectations. The Eligibility Specialist is accountable for: Completing assigned eligibility verification and follow-up activities accurately and within established timeframes. Maintaining accurate and complete patient insurance information and identifying and escalating eligibility concerns that may affect patient care, authorization, billing, or reimbursement. Maintaining appropriate communication with internal departments and external payer representatives. Meeting established productivity, quality, accuracy, and turn around-time standards, protecting confidential patient and company information, following all applicable Pinnacle Home Care policies and procedures and regulatory compliance. Requirements Qualifications 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. Benefits 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! Apply for this job