Finance/Accounting - Patient Financial Services

8 Hour Shift 7:30AM-4:00PM San Leandro Fairmont Campus - Hybrid High skill set in Medi-Cal Qualifications Minimum

3 - 5 years of experience in a hospital business environment performing billing and/or collections. OR two years of experience in a Revenue Cycle area within the Alameda Health System. Required

High school diploma or equivalent education.

The PFS Denial Specialist is responsible for validating dispute reasons following 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. Knowledge, Skills and Abilities * To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required.

Reasonable accommodations may be made to enable individuals with disabilities to perform the

. * Act in an appropriate and professional manner as defined by the company’s Standards of Behavior, Policy and Procedures, and Scope of Services. * Current office administrative practices and procedures. * Establish and maintain effective working relationships with a variety of individuals from various socioeconomic, ethnic and cultural backgrounds. * Excellent communication skills, both written and verbal; advanced business letter writing skills to include correct use of grammar and punctuation. * Intermediate computer skills including thorough understanding of the EHR system, Microsoft Office (Word, Outlook, Excel). * Intermediate knowledge of CPT and ICD-10 codes, coding and medical terminology. * Intermediate knowledge of insurance claims and insurance terminology. * Intermediate knowledge of UB-04 and Explanation of Benefits (EOB) interpretation. * Intermediate understanding of Explanation of Benefits form (EOB), Managed Care Contracts, Contract Language and Federal and State Requirements. * Role model AHS Standards of Behavior. * Should have a good understanding of payer contract language, and how to apply language to reimbursements. * Use independent judgment and initiative within established policies and procedures.