HOSPITAL BILLING SPECIALIST II

Samaritan Health; Northern (KY); Hybrid; USD 47,000 - 62,000; Full time

Job summary

Samaritan Health is seeking a Hospital Billing Specialist II to prepare, review, and submit complex claims across inpatient and outpatient services. You will resolve claim edits, correct denials, and ensure compliance with CMS, Medicaid, and payer guidelines while communicating with payers to resolve discrepancies.

You’ll join a remote-friendly team with opportunities to mentor staff, update SOPs, and contribute to process improvements in the revenue cycle.

Qualifications

• Strong working knowledge of UB-04 billing standards and CPT/HCPCS/ICD-10.
• Proficient in researching claim edits and resolving reimbursement issues.

Responsibilities

• Prepare, review, and submit complex hospital claims (inpatient, high-acuity outpatient, surgery).
• Resolve claim edits requiring in-depth research across EHR and billing systems.
• Correct, appeal, and resubmit complex denials related to medical necessity and payer rules.
• Ensure claims meet CMS, Medicaid, and commercial payer requirements.
• Follow up on aged accounts with emphasis on high balances.
• Perform root-cause analysis for denials with Revenue Integrity.
• Manage payer-specific work queues and maintain productivity and quality.
• Communicate with payers to resolve underpayments or escalate disputes.
• Maintain knowledge of NCCI edits, LCD/NCD, and revenue code usage.
• Ensure HIPAA and CMS compliance; participate in audits and training.
• Mentor teammates and assist leadership on workflow improvements.
• Collaborate with Revenue Cycle to identify trends and resolve issues.
• Assist with system updates and payer rule changes; test as needed.
• Overtime may be required during high-volume periods.

Skills

UB-04 billing

CPT/HCPCS ICD-10

Medicare/Medicaid regulations

Claim edits research

Authorization issues resolution

EHR/billing systems (Meditech, eCW,Med

Clearinghouse (Quadax)

Analytical problem-solving

Communication & documentation

Independent work & prioritization

Tools

Meditech

eCW

Medent

Quadax

Job description

## HOSPITAL BILLING SPECIALIST IIApply: Remote: Business Office: Full time: Posted Today: R3559Location:Business OfficeDepartment:01.8521 SMC PATIENT ACCOUNTINGPay Range:22.77 - 29.60Care 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 metSkills* 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)