EPIC (Certified Resolute HB, Resolute PB Claims Analyst)

Technical Specialist- Expert (HB, PB, Claims Analyst) (760597) REMOTE 12+ Months 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 NCDHHS 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.

Working Conditions: Essential:

• May be required to work after hours or on weekends as needed
• Infrequent travel
• Pass pre-employment drug test

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: Essential: Bachelor's degree or 8 years' experience in directly related field Credentials: Essential:

• Pass general background check
• Epic module certification as assigned
• Epic HB/PB Claims Certification

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