Epic HB/HB Claims Analyst

Computer Task Group, Inc•San Mateo, CA

2d•Hybrid

About The Position

CTG is seeking to fill an Epic HB/HB Claims Analyst position for our client. This role will play a critical part in designing, building, testing, and deploying HB and claims workflows, ensuring accurate billing, compliance, and efficient revenue cycle operations for the Phase 2 Epic implementation.

Requirements

Epic HB certification (required)
Strong understanding of hospital revenue cycle workflows and claims lifecycle
Experience with claim edits, billing rules, and workqueue configuration
Knowledge of EDI transactions (837I, 835) and clearinghouse processes
Experience with payer integrations and clearinghouses
Knowledge of denial management and revenue integrity processes
Experience with reporting tools (Epic Reporting Workbench, Clarity, Caboodle)
Strong analytical, problem-solving, and communication skills
Familiarity with regulatory requirements (CMS, HIPAA billing guidelines)
5+ years of experience with Epic Hospital Billing (HB) and HB Claims
At least one full Epic implementation experience required
Hands-on experience supporting Epic HB build, testing, and production support activities
Demonstrated experience in claims processing workflows, billing optimization, and denial reduction initiatives
Associates Degree / College Diploma required
Epic HB / HB Claims certification required
Excellent verbal and written English communication skills and the ability to interact professionally with a diverse group are required.

Responsibilities

Lead and support the design, build, and configuration of Epic Hospital Billing (HB) and HB Claims modules
Translate business requirements into functional system design
Configure charge capture, claim edits, workqueues, and billing rules
Collaborate with operational stakeholders to align workflows with system capabilities
Build and maintain claims processing workflows, including claim generation, edits, and submission
Configure electronic claims (837I), remittance processing (835), and payer-specific rules
Troubleshoot claim rejections and denials, and implement solutions to reduce errors
Develop and execute test plans, scripts, and scenarios (unit, integrated, and user acceptance testing)
Validate system functionality to ensure accurate billing and claims output
Support issue resolution and defect tracking
Provide go-live support, including command center participation
Troubleshoot real-time issues related to HB billing and claims
Assist in system stabilization and optimization post-implementation
Ensure compliance with regulatory requirements and payer guidelines (CMS, HIPAA billing standards)
Support reporting needs related to billing performance, claim status, and denial trends
Partner with compliance and revenue integrity teams
Work closely with Epic application teams, IT, revenue cycle leadership, and third-party vendors
Participate in cross-functional design sessions and workflow reviews