HOSPITAL BILLING SPECIALIST II

Location:

Business Office

Department:

01.8521 SMC PATIENT ACCOUNTING

Pay Range:

22.77 - 29.60

Care for our community, and your career.

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. 

Why work here?

Exceptional care starts with exceptional people. At Samaritan, everyone’s job is critical to the successful care of our patients. Be a part of an organization whose employees, medical staff, volunteers and students choose to spend their time here because they are dedicated, enthusiastic, truly care about making a difference…and are surrounded by over 2,500 others who feel the same way.

Become part of an organization whose ongoing strategic planning drives our organization forward and sets the tone for future growth and development. Samaritan is a fiscally sound and stable organization. Thanks to the hard work and dedication of our medical staff and employees combined with careful management, our bottom line is strong, which allows us to provide stable jobs, and offer ever-improving quality of care.

Enjoy the natural beauty of Northern New York, minutes from Lake Ontario and the St. Lawrence River. A safe community, low cost of living and minimal commute times mean more time for enjoying life outside of work. Exceptional, dedicated people, rewarding opportunities, an excellent compensation and benefit program, and the ability to shape healthcare in our community are some of the reasons to join Samaritan.

About Us

In 1881, we began caring for our neighbors as the House of the Good Samaritan in a home with five beds. Today, Samaritan Health is a comprehensive not-for-profit health system. And as we’ve grown to meet the changing needs of our region, we’ve held fast to our community roots.

At Samaritan, we’ve invested in the best medical talent, facilities and equipment to offer a full continuum of care close to home. That means our patients can spend more time healing and less time traveling out of the area for the care they need.

As the largest hospital and the largest private employer in the region, the health of our community is our priority – in fact, it’s our mission. That’s why Samaritan invests time and resources to support local non-profit organizations and events. It’s also why our people lend a hand to little league teams, churches and fundraisers—all to help Northern New York thrive.