Pinnacle Home Care

Billing Specialist

• Supervise, train, and mentor billing staff, assigning work to ensure all claims are processed according to company guidelines.
• Oversee the submission of Notice of Admissions (NOA), RAP (Requests for Anticipated Payment), and final claims in EMR systems.
• Conduct regular audits of patient records to ensure compliance with Medicare regulations and all payer standards.
• Monitor and reduce accounts receivable (A/R) days and denial rates, developing strategies to improve collections and reduce revenue leakage.
• Review and resolve complex denied claims, submitting appeals and managing the follow-up process.
• Generate and analyze daily/weekly/monthly billing reports to monitor trends and report to management.
• Partner with clinical managers, nurses, and clinicians to ensure OASIS documentation and physician orders support accurate billing.
• Assist in development of and enforce billing policies and procedures, keeping the team updated on payer changes.
• Assign any Office Authorization as needed for patient care to continue without delay, until authorization has been submitted and returned with a decision.
• Monitor Zendesk, WellSky fax inquiries, and incoming faxes throughout the day to update patient authorization status and adhere to any failed faxes in WellSky requiring more information to process authorization.
• Analyze and reconcile complex issues and problems.
• Prepare and analyze appropriate reports and other business correspondence.
• Identify needs and opportunities and present them to the supervisor with recommended solutions.
• Meet productivity goals assigned by the Authorization Supervisor.
• Adhere to federal, state, and agency regulations and policies to maintain confidentiality of patients and agency information per HIPPA requirements.
• Respond to all inquiries with a resolution to concerns and/or discrepancies.

Billing Supervisor

Medical Reviewer

• Review all incoming home health orders for clinical appropriateness
• Determine appropriate disciplines, frequencies, and visit types in line with agency protocols and referral source requirements
• Confirm compliance with CMS guidelines, Medicare Conditions of Participation (COPs), and internal agency standards
• Take and document verbal orders from physicians and referral sources accurately and efficiently
• Perform patient welcome calls to ensure a smooth, positive onboarding experience
• Triage and troubleshoot patient needs or concerns during intake conversations
• Maintain a warm, empathetic, and professional phone presence to reassure patients and referral partners
• Accurately document all intake and order-related activities in the EMR (WellSky/KanTime or similar)
• Ensure physician orders, care plans, and required documentation are completed, accurate, and properly uploaded
• Maintain an up-to-date understanding of home health regulatory requirements, including Medicare, CMS, and state guidelines
• Partner closely with Intake, Care Coordination, and Branch leadership to ensure timely patient starts of care

Clinical Review Specialist – LPN

Human Resources

• Assist with the onboarding process to ensure completion of all hiring-related paperwork.
• Assists with managing staff correspondence (i.e., new hires, promotions, terminations).
• Responsible for entering and maintaining EMR, payroll, and HRIS software.
• Help with questions related to company policies and procedures.
• Maintain current knowledge of state and federal accreditation requirements and guidelines.
• Maintain company policies and procedures.
• Manage personnel files.
• Notify staff when HR credentials are due to expire.
• Notify supervisors when 90-day and annual evaluations are due.
• Respond to correspondence received from outside organizations.
• Responsible for instruction and completion of all trainings/in-services.
• Implement the company’s mission and values to maintain a positive work environment.
• All other responsibilities as assigned.

Billing Supervisor

Clinical Review Specialist – LPN

HR Coordinator – Home Health Care