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Patient Financial Services Denial Specialist

Alameda Health System • San Leandro, CA, US • published 2026-10-10 21:03:06.188002

Description

**SUMMARY:** The PFS Denial Specialist is responsible for validating dispute reasons following an Explanation of Benefits (EOB) / Remittance Advice review, escalating payment variance trends and/or issues to management, and generating appeals for denied and/or underpaid claims. **DUTIES \& ESSENTIAL JOB FUNCTIONS:** NOTE: The following are the duties performed by employees in this classification. However, employees may perform other related duties at an equivalent level. Not all duties listed are necessarily performed by each individual in the classification. ESSENTIAL DUTIES AND RESPONSIBILITIES: 1\. Escalate denial or payment variance trends to the management team for payer escalation. 2\. Escalate exhausted appeal efforts for resolution. 3\. Follow specific payer guidelines for appeals submissions, paying close attention to the timelines for appeals. 4\. Generate an appeal based on the dispute reason and contract terms specific to the payer. This includes online provider disputes and reconsiderations. 5\. Other duties as assigned. 6\. Perform research and makes determination of corrective actions and takes appropriate steps and route account appropriately. 7\. Research contract ...

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