Epic Certified Analyst
Position Summary We are seeking an experienced Epic Claims Analyst to support and optimize Epic Claims workflows and related applications. The ideal candidate will possess strong analytical skills, hands-on Epic application experience, and a deep understanding of healthcare claims processing, adjudication, reimbursement, and payer interactions. The analyst will work closely with business users, operational teams, and technical teams to ensure efficient claims management and system performance.
Key Responsibilities
- Analyze, configure, maintain, and support Epic Claims functionality and related workflows.
- Gather business requirements from claims operations, billing teams, and stakeholders to design effective system solutions.
- Configure and maintain claim processing rules, claim edits, work queues, and reimbursement workflows within Epic.
- Investigate and resolve claim processing issues, claim rejections, denials, and system-related defects.
- Collaborate with internal teams and external payers to address claim submission and adjudication issues.
- Participate in system implementations, upgrades, optimization initiatives, and application enhancements.
- Develop and execute test plans, test scripts, and validation activities for system changes.
- Monitor claims processing performance and identify opportunities for workflow improvements.
- Provide end-user support, troubleshooting, and training related to Epic Claims functionality.
- Document system configurations, workflows, business requirements, and support procedures.
- Assist with data analysis, reporting, and operational metrics related to claims processing.
- Ensure compliance with healthcare regulations, payer requirements, and organizational standards.
Required Qualifications
- Bachelor's degree in Information Systems, Healthcare Administration, Business, Computer Science, or a related field.
- 5+ years of experience as an Epic Analyst supporting healthcare applications.
- Active Epic Certification in one or more of the following:
- Epic Claims
- Epic Professional Billing (PB)
- Epic Hospital Billing (HB)
- Strong understanding of healthcare claims processing, claim adjudication, reimbursement methodologies, and payer requirements.
- Experience with claim edits, denials management, remittance processing, and claims troubleshooting.
- Knowledge of healthcare industry standards including HIPAA, ICD-10, CPT, and HCPCS coding concepts.
- Experience with requirements gathering, workflow analysis, testing, implementation, and production support.
- Strong analytical, problem-solving, and troubleshooting skills.
- Excellent communication and stakeholder management abilities.
Preferred Qualifications
- Multiple Epic certifications (Claims, PB, HB).
- Experience with claim clearinghouses and electronic claim submission processes.
- Knowledge of Epic Reporting Workbench, Clarity, and operational reporting tools.
- Experience supporting healthcare payer or provider claims operations.
- Familiarity with SQL and healthcare data analysis.
Technical Skills
- Epic Claims Module
- Claims Processing & Adjudication
- Claims Edits & Work Queues
- Denial Management
- Electronic Claims Submission
- EDI Transactions (837/835)
- Reporting Workbench
- Clarity Reporting
- Healthcare Claims Operations
- System Testing & Validation
Key Competencies
- Claims workflow analysis
- Requirements gathering
- Root cause analysis
- Application configuration and support
- User training and documentation
- Cross-functional collaboration
- Process improvement and optimization
Certification Requirement Candidates must hold an active Epic certification in Epic Claims, Epic Professional Billing (PB), or Epic Hospital Billing (HB) and be in good standing with Epic certification requirements. Pay: $60.00 - $70.00 per hour License/Certification:
- Epic Certification (Required)
- Epic Professional Billing (Required)
- Epic Hospital Billing (Required)
- Epic Claims (Required)
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