About this role
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