Healthcare Eligibility Specialist

Pinnacle Home Care

. Verify patient insurance eligibility and benefits for new, returning, and existing patients.

Posted 10/22/2026part-timeRemote • Florida • United StatesJuniorWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in verifying patient insurance eligibility and benefits, with a strong understanding of healthcare payer systems and compliance with HIPAA regulations. Proficient in documenting and resolving discrepancies while maintaining high productivity and accuracy standards.

Highest-signal resume keywords

Insurance VerificationHealthcare Payer SystemsWellSky ExperienceHIPAA CompliancePatient Communication

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Insurance EligibilityBenefits DocumentationMedical BillingCoverage LimitationsPayer Information ProcessingElectronic Medical RecordsCopaymentsDeductiblesCoinsuranceEligibility Issues Resolution

Soft Skills

CommunicationCollaborationProblem-SolvingAttention to DetailTime Management

Tools & Technologies

WellSkyPayer PortalsHealthcare Information Systems

Industry Keywords

MedicareMedicaidManaged CareCommercial InsuranceHome Health

About the role

Key responsibilities & impact

Verify patient insurance eligibility and benefits for new, returning, and existing patients.
Review and resolve insurance eligibility issues in WellSky and other applicable systems.
Process and update insurance changes, payer information, and demographic or coverage information.
Document coverage dates, insurance details, copayments, deductibles, coinsurance, limitations, requirements, and out-of-network considerations.
Communicate eligibility changes, discrepancies, and coverage concerns to branches and internal departments.
Identify and escalate issues affecting patient services, authorizations, billing, or reimbursement.
Collaborate with the Eligibility Team Lead and Authorization Manager on complex eligibility matters and payer requirements.
Communicate with patients, insurance companies, payer representatives, branch personnel, and internal departments.
Respond to eligibility-related inquiries and resolve discrepancies or account issues.
Maintain complete eligibility verification documentation and monitor assigned accounts.
Meet productivity, accuracy, quality, and turnaround-time expectations.
Protect confidential patient information and comply with HIPAA and applicable regulations.
Participate in training, staff meetings, quality initiatives, and process-improvement activities.

Requirements

What you’ll need

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.
Ability to work Saturdays and Sundays in 8-hour shifts from 8:30 AM–5:00 PM Eastern Time, with a Monday start.
Ability to comply with HIPAA, privacy, security, regulatory, attendance, and company requirements.

Benefits

Comp & perks

Personalized, One-on-One Care: Help patients heal and regain their independence by delivering individualized care in the comfort of their homes.
Free Continuing Education Units (CEUs) to support licensure and career advancement.
Employee referral program where you can earn rewards.
Flexible scheduling.
Supportive and collaborative team culture.
Equal opportunity and inclusive workplace.