Remote Hospital Billing Specialist II - Claims & Denials Expert

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

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.