HB/PB Claims Analyst

Position Summary:

The Epic Payors Contract Configuration Analyst is responsible for the loading, maintenance, and troubleshooting of all payor contracts for a dynamic health system. This role will perform payor contract builds ensuring quality and accuracy, manages contract build deficiencies, audits peer-created contract builds, and performs regularly scheduled quality checks and fee schedule upload maintenance.

The Epic Payors Contract Configuration Analyst collaborates with the Revenue Cycle Management team to address contract related build issues, and holds primary responsibility for the design, build, testing, validation, and ongoing support of the Epic contract management applications. The position requires deep knowledge of reimbursement methodologies of government payors, managed care commercial payors, software functionality and the revenue cycle workflows in Epic.

Key Responsibilities:

Interpret Contract Terms: Partner with Director of Payor Solutions Compliance and the team to review and clarify contract language.

Epic System Configuration: Design, build, validate, and support the Epic contract build in alignment with revenue cycle workflows.

System Design & Validation: Participate in design and advanced validation sessions to ensure accurate contract build configuration.

Testing & Documentation: Conduct structured application testing and maintain thorough documentation of results.

Release Management: Review and test new builds and releases prior to production deployment.

Resolve Contract Variances: Troubleshoot and correct discrepancies in contract builds to ensure accuracy and compliance.

Manage Adjustments: Post contractual adjustments promptly and maintain weekly updates on outstanding items and build deficiencies.

Issue Management: Track, update, and resolve contract build issues efficiently.

Training Development: Collaborate with team during peer reviews to establish new workflows as necessary.

Technical Support: Troubleshoot contract build related problems reported by Revenue Cycle Management team as end-users.

Continuous Improvement: Identify and recommend contract build enhancements to optimize performance.

Qualifications:

Education: Bachelors degree in Health Information Management, Healthcare Administration, Computer Science, or a related field preferred.

Epic Certification in Contract Management or related module(s) for hospital and professional.

Experience: Minimum of 5 years of experience working with Epic systems, specifically in Contract management or similar roles.

Skills:

Must have the ability to analyze complex data, identify trends, and draw actionable insights to optimize contract performance.

Must have a strong understanding of healthcare contracts, including terms, billing codes (CPT, HCPCS, MSDRG, APC, ICD-10, etc.), & government reimbursement methodologies.

Excellent communication abilities.

Required Skills :

Basic Qualification :

Additional Skills :

Background Check : No

Drug Screen : No