Epic PB Analyst

This is a fully remote position, open to applicants in United States.

📋 Description

• Oversee the migration of relevant Optum Claims Manager edits to Epic charge review edits.

• Assess, configure, test, and enhance Epic charge review edits to ensure precise and compliant billing workflows.

• Develop and sustain regulatory and coding-related edits, including LCD/NCD, CCI/NCCI, and MUE.

• Conduct cleanup and optimization of the Epic Charge Router by identifying outdated, redundant, or ineffective rules and configurations.

• Review charging workflows and suggest enhancements to boost automation, accuracy, and efficiency.

• Configure and optimize Professional Billing workqueues that support charge review and billing operations.

• Resolve issues related to charge routing, edits, and workqueues while identifying root causes.

• Collaborate with Revenue Cycle, Coding, Compliance, and operational stakeholders to convert regulatory and business requirements into Epic configurations.

• Independently manage assigned workstreams, encompassing requirements gathering, build, testing, validation, documentation, and implementation.

• Facilitate knowledge transfer and documentation to ensure the long-term sustainability of updated Epic workflows.

⛳️ Requirements

• Current Epic Resolute Professional Billing Administration certification is mandatory.

• Extensive hands-on experience with Epic Resolute Professional Billing build and configuration.

• Proven experience with Epic Charge Router, including rule configuration, troubleshooting, cleanup, and optimization.

• Solid understanding of charge review edits, charging workflows, and PB workqueues.

• Practical experience in implementing or maintaining healthcare regulatory and coding edits, such as LCD/NCD, CCI/NCCI, and MUE requirements.

• Proficiency in translating billing and regulatory requirements into Epic configurations.

• Comprehensive understanding of the revenue cycle and the connections between charging, coding, claims, and billing workflows.

• Capability to independently lead intricate Epic PB initiatives from analysis through to implementation.

• Excellent communication skills with the ability to work collaboratively with technical, operational, coding, compliance, and Revenue Cycle teams.

• Prior experience in transitioning edits or functionalities from Optum Claims Manager into Epic is preferred.

• Experience in large-scale Charge Router cleanup or optimization projects is preferred.

• Familiarity with reducing dependence on third-party claims or billing tools by integrating functionality directly into Epic is preferred.

🏝️ Benefits

• Six-month contract opportunity.

• Remote position.

• Pay rate determined by experience and qualifications.