Epic PB HB Claims Analyst
*This is a remote position
*This is a 5 month long contract position
Description:
- The client is a seeking an experienced Epic PB HB and Claims Analyst.
Competency Model:
Business Acumen:
- Understands the organization’s strategic goals and how department goals support the organization.
- Seeks opportunities to extend and deepen learning of organization and area.
- Shares new information and knowledge with others.
- Be curious question your assumptions when presented with an issue or question.
- Self-motivated to research and learn new information and explore new options.
- Seeks to maximize potential abilities and helps others.
- Follow instructions written or oral.
- Adhere to all scheduling and attendance requirements.
- Honesty truthfulness reliability accountability
- Read understand and apply regulations and policies.
- Knowledge of relevant privacy regulations such as The Privacy Act Freedom of Information Act and HIPPA law
- Knowledge of revenue cycle billing hospital billing professional billing and claims processing operations and workflows
- Knowledge and understanding of third-party applications.
- Establishes professional working relationships.
- Communicates verbally with team departments guests and management.
Communication:
- Expresses oneself clearly in conversations business writing and interactions with others.
- Delivers oral and written communications that are impactful and persuasive to their intended audiences.
- Demonstrates a high level of emotional intelligence in the face of conflict.
- Responds to tickets and emails in a timely manner.
Planning and Organizing:
- Manages and monitors time and resources effectively to complete assignments.
- Utilizes resources and gets involvement from others where appropriate.
- Shares information materials and time readily with others who need them
Teamwork:
- Encourages participation from all team members regardless of role within organization supports team members and customers.
- Identifies and works through conflict that may derail the collaborative process.
- Holds self and others accountable to create unifying goals and measure with peers.
- Support the clients analyst team through knowledge sharing and concise documentation.
- Applies the knowledge of fundamental IT concepts.
- Asks questions diligently seeks and is receptive of guidance.
Drive Change:
- Anticipates potential concerns/resistance to change and takes constructive steps to address them.
- Encourages others to adopt new methods or technologies that add value or improve performance.
- Keeps others focused on critical goals and deadlines through periods of change or ambiguity.
- Be flexible and adopt new processes and methods.
- Stay positive in attitude and actions.
Skills/Knowledge/Experience:
- Must have strong leadership and communication skills with the ability to effectively present information to clinical and business leaders within the organization.
- Must have experience with Epic PB HB and Claims. 8 years required.
- Ability to work in small groups under tight project deadlines.
- Working closely with business and revenue cycle leaders around Epic workflow and to translate business needs Epic billing functionality.
- Must possess Epic certification Resolute PB HB and Claims.
- Minimum of five years progressive revenue cycle/healthcare experience with demonstrated experience in Epic build.
- Self-starter with demonstrated teamwork communication skills.
- Excellent communication and collaboration skills.
- Excellent verbal and written English communication skills and the ability to interact professionally with a diverse group are required.
- Experience working with Third Party Vendors such as Experian Relay Health and Hyland OnBase.
- Knowledge of revenue cycle billing hospital billing professional billing and claims processing operations and workflows
- Rapid Retest
- Payer/plan creation and maintenance
- PLBs
- Charge Router
- Contracts
- Behavioral Health
- Long term care psychiatric billing
- CMS IPF PPS billing regulations
- Substance abuse billing – IOP methadone dosing
- Medicare exhaust billing
- No-pay claims.
- Claim splits/interim claims.
- Cash Management
- Self-pay remittance
- Developing testing scripts
Responsibilities:
- Analyzes documents and communicates business requirements for new system functionality and enhancements to existing functionality.
- Test system changes to ensure that they meet business requirements and do not adversely impact other areas of the Epic system.
- Acts as the primary support contact for the application’s end-users.
- Identifies issues that arise in their application areas and issues that impact other application teams and works to resolve them
- Guides workflow design builds tests the system and analyzes other technical issues associated with Epic software
- Identifies implements completes integrated testing and communicates requested changes to the Epic system
- Works with Epic representatives and end users to ensure the system meets the organization’s business needs regarding the project deliverables and timeline
- Performs in-depth analysis of current and future workflows data collection report details and other technical issues associated with the Epic EHR and designated third-party applications
- Partners with quality operational and business leaders on system design and optimization to meet quality safety financial and efficiency needs
- Collects requirements regarding potential system enhancements or new system implementation and prepares details of specifications needed prioritizes and implements requested changes to the system.
- Investigates standardization and process improvement opportunities by rounding within revenue cycle areas while making build decisions.
- Validates that data is accurate and meets business requirements.
- Completes integrated testing to test system changes in all Epic environments to ensure that they meet business requirements and do not adversely impact other areas of the system.
- Troubleshoots and identifies root causes and documents problems of simple to medium complexity for assigned applications and systems.
- Maintains data integrity and security for assigned applications and systems.
- Develops system documentation as assigned per standards.
- Develops communication-related education efforts for deployments upgrades optimizations and other system changes as assigned.
- Stays current on Epic application releases and participates in upgrade planning and testing.
- Participates in performance improvement activities to measure assess and improve the quality of assigned work area
Education:
- Bachelor’s degree or 8 years experience in directly related field
Certifications
- Epic module certification as assigned
- Epic HB/PB Claims Certification
Required Skills/Knowledge/Experience:
- Must have strong leadership and communication skills with the ability to effectively present information to clinical and business leaders within the, Required 3 Years
- Must have experience with Epic PB, HB, and Claims, Required 8 Years
- Ability to work in small groups under tight project deadlines, Required 3 Years
- Working closely with business and revenue cycle leaders around Epic workflow and to translate business needs Epic billing functionality, Required 3 Years
- Must possess Epic certification, Resolute PB, HB, and Claims, Required
- Minimum of five years’ progressive revenue cycle/healthcare experience with demonstrated experience in Epic build, Required 5 Years
- Self-starter with demonstrated teamwork & communication skills, Required 3 Years
- Excellent communication and collaboration skills, Required 3 Years
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