Patient Financial Services Denials & Appeals Specialist

Alameda Health System; San Leandro (CA); On-site; USD 47,000 - 57,000; Full time

Job summary

Alameda Health System is seeking a PFS Denial Specialist to validate dispute reasons after EOB reviews and escalate payment variance trends to management. The role includes generating timely appeals for denied or underpaid claims and coordinating with Revenue Integrity, HIM, and ancillary departments to ensure accurate denial coding in the EHR.

Minimum 3–5 years in a hospital billing environment are required, with strong Excel, Word, and Zoom skills.

Qualifications

• Minimum 3–5 years in hospital billing/collections
• Experience handling facility or professional billing
• Ability to analyze trends and communicate with leadership
• Knowledge of HIPAA requirements and billing regulations
• Proficient in Excel and Word; strong Zoom presentation skills

Responsibilities

• Escalate denial or payment variance trends to management for payer escalation.
• Escalate exhausted appeal efforts for resolution.
• Follow payer guidelines for appeals submissions with attention to timelines.
• Generate appeals based on dispute reasons and contracts.
• Research and determine corrective actions; route accounts as needed.
• Coordinate with Revenue Integrity, HIM, and other departments for denial reasons.
• Prepare supporting documentation for appeals and referrals to supervisors for refunds.
• Research contract terms and terms & conditions for adjudication issues.

Skills

Multitasking

Stakeholder communication

Data analysis

Payer relations

Deadline management

Education

High school diploma/GED

Some college preferred

Tools

Excel

Word

Zoom

Job description

Alameda Health System is seeking a PFS Denial Specialist to validate dispute reasons after EOB reviews and escalate payment variance trends to management. The role includes generating timely appeals for denied or underpaid claims and coordinating with Revenue Integrity, HIM, and ancillary departments to ensure accurate denial coding in the EHR.

Minimum 3–5 years in a hospital billing environment are required, with strong Excel, Word, and Zoom skills.