Denials & Appeals Specialist for Revenue Integrity

washingtonhospital; Fremont (CA); On-site; USD 45,000 - 66,000; Full time

Job summary

Washington Hospital in Fremont, CA is hiring a Billing Denials Specialist to manage end-to-end denial and appeals processes. You will analyze payer denials, prepare timely, well-supported appeals, and partner with clinical, coding, and payer-relations staff to reduce future denials.

Ideal candidates have 2–4 years in revenue cycle operations, strong knowledge of ICD-10/CPT/HCPCS, and proficiency with Epic and payer portals; CCS/CPC/CRCR credentials are a plus.

Qualifications

• Associate's or Bachelor's degree in Health Information Management or related field; equivalent work experience considered.
• Minimum of 2-4 years in medical billing, claims denial management, appeals, or revenue cycle operations.
• Working knowledge of ICD-10, CPT, HCPCS coding, medical terminology, and payer reimbursement methodologies.
• Familiarity with Medicare, Medicaid, and commercial payer denial and appeal guidelines.
• CCS/CPC/CRCR credential a plus; proficiency with EHR and billing systems.
• Strong written and verbal communication skills.

Responsibilities

• Meets or exceeds targets for denial resolution and appeal submission.
• Overturns denials through well-documented, evidence-based appeals.
• Tracks outcomes and ensures timely filing deadlines are met.
• Coordinates with coding, clinical documentation, and billing teams to gather documentation.
• Maintains a tracking log or dashboard of denial status and outcomes.
• Leads denial-trend review meetings with stakeholders.

Skills

Communication skills

EHR proficiency

Denial management

Billing knowledge

Written/verbal communication

Education

Health Information Management degree

Revenue cycle experience

Tools

Epic

Kodiak

Optum360

Availity

Job description

Washington Hospital in Fremont, CA is hiring a Billing Denials Specialist to manage end-to-end denial and appeals processes. You will analyze payer denials, prepare timely, well-supported appeals, and partner with clinical, coding, and payer-relations staff to reduce future denials.

Ideal candidates have 2–4 years in revenue cycle operations, strong knowledge of ICD-10/CPT/HCPCS, and proficiency with Epic and payer portals; CCS/CPC/CRCR credentials are a plus.