PFS Denials & Appeals Specialist

Alameda Health System; San Leandro (CA); On-site; USD 47,000 - 56,000; Full time

Job summary

Alameda Health System is seeking a PFS Denial Specialist to validate dispute reasons after EOB/Remittance review and to escalate payment variance issues to management. The role includes generating appeals for denied or underpaid claims and coordinating with Revenue Integrity, HIM, and related departments.

The ideal candidate has 3-5 years in hospital billing/collections and strong Excel, Word, and Zoom skills, with a thorough understanding of HIPAA and billing regulations.

Qualifications

• High school diploma or GED required; some higher education preferred.
• Strong data collection and analysis skills with ability to identify trends and transport insights to leadership.
• Excellent communication across stakeholders via in-person, email, and Zoom.
• Proficient with Excel and Word; comfortable with standard office software.

Responsibilities

• Validate dispute reasons and ensure EHR coding reflects denial reasons.
• Escalate denial or payment variance trends to management for payer escalation.
• Generate appeals based on dispute reasons and payer terms (including online disputes).
• Follow payer guidelines and deadlines for appeals submissions.
• Coordinate with Revenue Integrity, HIM, and ancillary departments as needed.

Skills

Data analysis

Attention to detail

Communication

Zoom

Education

High school diploma/GED

Tools

Excel

Word

Job description

Alameda Health System is seeking a PFS Denial Specialist to validate dispute reasons after EOB/Remittance review and to escalate payment variance issues to management. The role includes generating appeals for denied or underpaid claims and coordinating with Revenue Integrity, HIM, and related departments.

The ideal candidate has 3-5 years in hospital billing/collections and strong Excel, Word, and Zoom skills, with a thorough understanding of HIPAA and billing regulations.