Title: EPIC PB Claims Analyst (Claims Certification)
Location: San Antonio, TX (Remote)
Type: Contract, 6 months
Overview:
ZipStaff is hiring an EPIC PB Claims Analyst (Claims Certification) for our client, a leading healthcare organization. This 6-month contract is a 100% remote role focused on designing, building, and optimizing Professional Billing (PB) claims processing logic and workflow engines in Epic Resolute PB and Claims. You will focus on claim statusing (276/277 workflows, clearinghouse integration, and workqueues) so claims move through adjudication to clean submission and rapid reimbursement. An active vendor Claims Certification (such as Epic Claims Certification) and deep hands-on claims build expertise are required.
Responsibilities:
- Build and configure automated claim statusing workflows using ANSI ASC X12 EDI transactions (276/277), including clearinghouse integration, 999/277CA acknowledgment ingestion, and payer statusing bridges.
- Construct and refine Account and Claim Status Workqueues with automated routing, and analyze lag times and payer response trends to reduce Days in A/R.
- Configure and maintain the Claims build, Claim Definition files (CDF), payer output formats (CMS-1500 / 837P), claim edit rules, and validation criteria to drive first-pass clean claim rates.
- Manage payer ID mapping, provider credentialing mapping and overrides, taxonomy crosswalks, and Revenue Module Object (RMO) billing rules.
- Conduct unit, integrated, and end-to-end testing for new claims build, system upgrades, and annual regulatory and payer updates.
- Partner with billing and Revenue Integrity teams on root-cause analysis of pre-bill edits, clearinghouse rejections, and post-submission denials, and troubleshoot claims interface and EDI engine issues.
Required Qualifications:
- Active vendor Claims Certification is required (for example, Epic Claims Certification / Resolute Claims Administration).
- 3-5+ years of hands-on technical build and configuration experience in healthcare revenue cycle applications, with direct ownership of PB claims engine workflows.
- Proven expertise in Claim Definitions (CDF), Claim Logic Rules, 837P EDI formatting, and claim edit workqueue configuration.
- Extensive experience with EDI standards, specifically 276/277 claim statusing, 837P claim generation, and 835 payment remittance integration.
- Bachelor's degree in Healthcare Information Systems, Computer Science, Business Administration, or equivalent relevant experience.
Preferred Qualifications:
- Additional or dual certification in Epic Resolute Professional Billing (PB) Administration or Epic Charge Router.
- Experience with healthcare clearinghouses (for example, Change Healthcare, Experian Health, Waystar, or Availity).
- Background in Single Billing Office (SBO) workflows and integration with Hospital Billing (HB) and Cadence scheduling.
- Proficiency with SQL, Epic Reporting Workbench, or Radar Dashboards to monitor claims throughput and workqueue health.
Benefits:
- Health Insurance
- Dental Insurance
- Vision Insurance
- 401(k) + matching
- Paid time off
- Referral Program
About ZipStaff:
ZipStaff connects skilled technology professionals with leading organizations across the United States, matching top talent with impactful contract and full-time opportunities.
To apply, submit your resume through this posting. Qualified candidates will be contacted by a ZipStaff recruiter.