CAH Biller – Epic (Critical Access Hospital Billing Specialist) at Cpsi

Job description

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

Requirements

Must-haves

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
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

Nice-to-haves

Preferred Experience with Medicare Part A billing and reimbursement methodologies

Application prep

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Platform: workday
Effort: long