Analysis Skills, Billing, Claims Management, Content Management Systems (CMS), Current Procedural Terminology (CPT), Detail Oriented, Epic Resolute (Patient Accounting), Epic Systems, Healthcare Common Procedure Coding System (HCPCS), Healthcare Reimbursement, Hospital, ICD-10, Insurance Documentation, Maintain Compliance, Medicaid, Medical Billing, Medical Coding, Medicare, Medicare Reimbursement, Production Systems, Production Volume, Regulatory Compliance, Reimbursement, Reimbursement Guidelines, Time Management
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