We are seeking an experienced Critical Access Hospital (CAH) Biller with strong Epic expertise to support full-cycle facility billing and reimbursement. This role is responsible for managing UB-04 claims in a CAH environment, with a focus on Medicare cost-based reimbursement, claim accuracy, and timely follow-up.
The ideal candidate has hands-on experience billing for CAHs, understands the nuances of Medicare reimbursement methodologies, and is proficient in Epic billing workflows.
Key Responsibilities
- Prepare, review, and submit UB-04 (CMS-1450) claims for Critical Access Hospital services
- Utilize Epic (Resolute Hospital Billing) to manage claims, work queues, and billing edits
- Ensure accurate billing aligned with CAH cost-based reimbursement guidelines
- Review and resolve claim edits, rejections, and denials within Epic work queues
- Perform timely follow-up on unpaid or underpaid claims, particularly Medicare accounts
- Analyze remittance advice (RA) and Explanation of Benefits (EOBs) to resolve discrepancies
- Collaborate with coding, clinical, and revenue cycle teams to ensure billing accuracy
- Maintain compliance with CMS regulations and CAH-specific billing requirements
- Document account activity and maintain detailed notes within Epic
Qualifications
Required
- 2+ years of hospital/facility billing experience, preferably in a CAH setting
- Hands-on experience with Epic Resolute Hospital Billing
- Strong knowledge of UB-04 claim forms
- Experience with Medicare billing, especially CAH cost-based reimbursement
- Proven ability to resolve denials, edits, and payment variances
- High attention to detail and accuracy
Preferred
- Experience with Medicare Part A billing and reimbursement methodologies
- Familiarity with other payer types (Medicaid, commercial)
- Understanding of ICD-10, CPT, and HCPCS coding (facility-side)
- Experience working in a remote, high-volume production environment
