HOSPITAL BILLING SPECIALIST II

Location:

Business Office

Department:

01.8521 SMC PATIENT ACCOUNTING

Pay Range:

$22.77 - $36.43

Care for our community, and your career.

Hospital Billing Specialist II - ON SITE IN WATERTOWN NY

Reporting to the Hospital Billing Supervisor, the Hospital Billing Specialist – Level 2 is an experienced billing professional responsible for accurately preparing, reviewing, and submitting complex hospital claims to government and commercial payers. This role requires advanced knowledge of billing rules and regulations across 2 or more payers or account types. This role also serves as a departmental resource assisting with training and helping leadership identify trends and process improvement opportunities.

Education & Experience

• *This role requires Certified Professional Biller Certification (CPB) within 6 months of hire. This certification is offered through The American Academy of Professional Coders (AAPC).
• High school diploma or equivalent required; Associate or Bachelor’s degree in business, Healthcare Administration, or related field preferred
• 2–4 years of hospital billing or revenue cycle experience required
• Experience working multiple payers and/or account types required
• Prior experience working complex claims or denials strongly preferred

Duties and Responsibilities

• Prepare, review, and submit complex hospital claims, including inpatient, high‑acuity outpatient, surgical, clinic and specialty services
• Resolve claim edits requiring in‑depth research across multiple systems (EHR, coding, patient access, documentation)
• Correct, appeal, and resubmit complex denials related to medical necessity, coding, bundling, or payer-specific rules
• Ensure claims meet CMS, Medicaid, and commercial payer requirements for coverage, authorization, and documentation

• Perform detailed follow‑up on aged accounts, with emphasis on high‑balance or problematic claims
• Conduct root‑cause analysis for recurring denials and collaborate with coding or revenue integrity to prevent future issues
• Manage payer-specific work queues and maintain productivity and quality standards
• Communicate directly with payers to resolve underpayments, request reconsiderations, or escalate disputes

• Maintain a strong understanding of billing guidelines, including NCCI edits, LCD/NCD requirements, and revenue code usage
• Ensure all work adheres to HIPAA, CMS regulations, and organizational compliance standards
• Participate in internal audits and assist leadership in correcting workflow gaps or documentation issues

• Serve as an escalation point for Hospital Billing Specialist team members
• Provide guidance, mentoring, and informal training to support skill development across the team

• Collaborate with Revenue Cycle to identify trends, investigate issues, and resolve claims issues
• Assist with updating reference materials, payer matrices, and departmental SOPs
• Identify opportunities to streamline billing processes and improve clean claim rates
• Provide feedback to leadership on system issues, payer trends, and workflow gaps
• Assist with testing and implementation of system updates, new payer rules, or operational changes
• May require occasional overtime during high‑volume periods or special projects
• This role offers flexible remote work options, provided that all performance standards and job responsibilities are consistently met

Skills

• Strong working knowledge of UB‑04 billing standards, CPT/HCPCS, ICD‑10, and Medicare/Medicaid regulations
• Skill in researching and resolving claim edits, authorization issues, and reimbursement discrepancies
• Proficiency with EHR and billing systems (e.g., Meditech, eCW, Medent) and clearinghouse platforms (Quadax)
• Excellent analytical and problem‑solving skills
• Strong communication, documentation, and customer service abilities
• Ability to work independently with minimal supervision and manage competing priorities

Work Shift:

FLSA7DAY- 8 Hours Day Shift (United States of America)

Position Hours:

80

Samaritan is an Affirmative Action/Equal Opportunity Employer. Women, Minorities, Disabled, and Veterans are encouraged to apply.