Job Description
Required Skills & Qualifications
- Experience: 5+ years of experience working with EPIC systems in an analyst or architect capacity within a healthcare setting
- Epic Certification: Active Epic certification(s) in relevant Revenue Cycle modules (e.g., Resolute PB, Resolute HB, Claims, Tapestry) is required.
- Technical Skills: In-depth knowledge of healthcare revenue cycle operations, electronic claims processing standards (e.g., EDI, specific claim forms), system integration standards such as HL7 & FHIR, and system configuration. Strong analytical and problem-solving skills are essential.
- System Architecture & Design: Lead the design and architecture of the Epic Claims modules, including Resolute Professional Billing (PB) and Hospital Billing (HB), focusing on claims, billing, and accounts receivable workflows.
- Implementation & Configuration: Plan, configure, test, and implement Epic software updates and new functionality, translating complex business requirements into practical system solutions.
- Workflow Analysis & Optimization: Collaborate with clinical and administrative leadership to perform workflow analysis, identify areas for improvement, and optimize system use to enhance efficiency and ensure regulatory compliance.
- Integration Management: Design and manage integrations between Epic and third-party systems related to claims submission, payment processing, and other financial operations.
- Analyze business requirements and translate them into scalable, secure, and compliant solution designs for healthcare and insurance domains.
- Configure and optimize EPIC system workflows to support health insurance processes, including eligibility, claims management, billing, and prior authorization.
- Ensure interoperability between EPIC modules and external payer systems, utilizing standards such as HL7, FHIR, and EDI for robust data exchange.
- Collaborate with business analysts, project managers, and technical teams to validate requirements and design effective solutions.
- Facilitate workshops with clinical, administrative, and payer stakeholders to gather insights and continuously improve workflows.
- Configure EPIC modules (e.g., Tapestry, Resolute, Benefits Engine) for insurance-related functionalities and support integration strategies for claims processing, eligibility verification, and premium billing.
- Provide expert guidance on HIPAA compliance and data security best practices throughout solution design and implementation.
- Develop comprehensive solution design documentation, including data flow diagrams and integration specifications, maintaining compliance with organizational architecture standards and regulatory requirements.
- Act as a subject matter expert for troubleshooting and optimization, leading detailed design efforts and workflow planning within project squads.
- Translate complex business requirements into clear, actionable technical specifications and contribute to user story creation, ensuring acceptance criteria are well-defined.
- Develop and maintain design documentation, updating regularly throughout the project lifecycle to ensure accuracy and completeness.
- Collaborate with technical SMEs to provide necessary details for successful completion of development stories.
- Lead design and technical discussions across squads and teams to ensure alignment, integration, and successful project outcomes.
- Partner with Product Managers and Scrum Masters for sprint and Program Increment (PI) planning, and work closely with other squads to define feature strategies for projects and initiatives.
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