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.