CAH Biller - Epic (Critical Access Hospital Billing Specialist)

About the 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