HOSPITAL BILLING SPECIALIST II

Samaritan Health Services

1d•$23 - $36•Hybrid

About The Position

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.

Requirements

Certified Professional Biller Certification (CPB) within 6 months of hire.
2–4 years of hospital billing or revenue cycle experience required
Experience working multiple payers and/or account types required
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

Nice To Haves

Associate or Bachelor’s degree in business, Healthcare Administration, or related field preferred
Prior experience working complex claims or denials strongly preferred

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