Patient Engagement Insurance Verification Specialist

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 delivered high-quality, patient-centered care for over two decades. We are growing and looking for a Patient Engagement Insurance Verification Specialist to join our award-winning team.

Position Overview

The Patient Engagement Insurance Verification Specialist is a critical operational role supporting the Patient Engagement Team (PET). This position serves as the insurance and eligibility gatekeeper for all PET-generated leads to ensure:

• Discharge lists are properly filtered


• Insurance eligibility is verified prior to outreach


• Expired or ineligible payers are removed


• Valid Medicare opportunities are prioritized


• All cases are accurately tagged and documented in WellSky

This is not a passive verification role. This position actively supports volume growth by increasing conversion rates, eliminating wasted outreach, and preventing downstream intake denials.

Core Responsibilities

1. Discharge Filtering & Lead Preparation

• Pull and review discharge lists (30–60-day lookback) in coordination with Data and Intake teams


• Remove:
  
  
  
  • Expired or inactive insurance
  
  
  • Managed care plans not eligible for PET outreach
  
  
  • Hospice, nursing home, or excluded patient categories
  
  
  • Approved Do Not Call exceptions (VA, ACO, etc.)
  
  
  
  


• Deliver a clean, actionable PET call list monthly

2. Insurance Eligibility Verification

• Verify Medicare eligibility and secondary coverage prior to PET outreach


• Confirm:


• 
  
  
  
  • Active coverage
  
  
  • Benefit period status
  
  
  • Home health eligibility
  
  
  • Authorization requirements (if applicable)
  
  
  
  


• 
  

  Document all verification details accurately in WellSky

  
  

3. Case Monitoring & Intake Alignment

• Track all PET-pending cases daily


• Identify:


• 
  
  
  
  • Missing orders
  
  
  • Authorization delays
  
  
  • Intake denials due to “no new skill”
  
  
  
  


• Escalate issues to the PET Manager and Intake leadership immediately


• Partner with Intake to resolve documentation gaps before decline decisions are finalized

4. Tagging & Reporting Accuracy

• 
  

  Ensure all PET cases are:

  
  
  
  
  • Properly tagged in WellSky
  
  
  • Assigned to the correct CC
  
  
  • Flagged for bonus eligibility
  
  
  
  


• Maintain clean, accurate reporting


• Provide weekly PET status reports including:
  
  
  
  • Leads received
  
  
  • Verified
  
  
  • Contacted
  
  
  • Pending
  
  
  • Admitted
  
  
  • Declined (with reason)
  
  
  
  

5. Continuous Improvement

• Identify recurring denial trends and report to PET leadership


• Assist in refining lead filters to improve conversion rates


• Support PET training by educating team members on:


• 
  
  
  
  • Medicare eligibility basics
  
  
  • Common authorization pitfalls
  
  
  • Documentation red flags
  
  
  
  

Required Qualifications

• 2+ years of healthcare insurance verification experience (Medicare strongly preferred)


• Experience in Home Health, CHHA, or post-acute settings preferred


• Strong working knowledge of:
  
  
  
  • Medicare eligibility
  
  
  • Benefit periods
  
  
  • Prior authorizations
  
  
  • Secondary payer coordination
  
  
  
  


• EMR experience (WellSky preferred)


• Ability to manage and track high-volume cases

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!