Hospital Billing Specialist Ii

Position: HOSPITAL BILLING SPECIALIST II
## HOSPITAL BILLING SPECIALIST IIApplyremote type:
Onsite locations:
Business Office time type:
Full time posted on:
Posted Todayjob requisition :
R3329

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:

** FLSA7

DAY- 8 Hours Day Shift (United States of America)
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