Pinnacle Home Care

• 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.

• 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

• 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.

• Referral & plan-of-care execution: Triage new referrals, confirm required disciplines, align care plans and goals, and update alerts/journal notes. • Episode monitoring & case conferencing: Track cases through audits and case conferences; be available during operating hours for clinician questions. • Field coaching: Conduct ride-alongs and field coaching as clinically indicated, including for onboarding, performance remediation, or quality improvement initiatives. • Documentation & OASIS accuracy: Remove barriers to timely notes, enforce SOPs, and ensure OASIS and care plans reflect current status; promote appropriate Telehealth and Patient Portal use. • Performance management: Hold regular 1:1s with assigned staff and the Clinical Assistant; reinforce standards, issue corrective actions when needed, and support ongoing competency. • Quality inputs: Conduct quarterly record reviews; share findings and recommendations to DCS/ADCS; assist in branch QI tasks as directed. • Talent & onboarding support: Help screen/interview candidates, recommend hires, and execute onboarding checklists and early-tenure coaching. • Training delivery: Facilitate in-service sessions and education assigned by DCS; track completion and retention of key practices. • Culture & professionalism: Model mission/values; maintain a respectful, compliant environment with patients, colleagues, vendors, and leaders. • Other branch support: Perform additional tasks assigned by the DCS/ADCS/Regional Leadership to meet patient care and operational needs.