EPIC PB Claims Analyst (Claims Certification)

ZipStaff•San Antonio, TX

1d•Remote

About The Position

ZipStaff is hiring an EPIC PB Claims Analyst for a leading healthcare organization. This is a six-month, 100% remote contract role focused on designing, building, and optimizing Professional Billing (PB) claims processing logic and workflow engines in Epic Resolute PB and Claims. The role focuses on claim statusing—including 276/277 workflows, clearinghouse integration, and workqueues—to move claims through adjudication toward clean submission and rapid reimbursement. Active vendor Claims Certification and deep hands-on claims build expertise are required.

Requirements

Active vendor Claims Certification, such as Epic Claims Certification / Resolute Claims Administration.
3–5+ years of hands-on technical build and configuration experience in healthcare revenue cycle applications, with direct ownership of PB claims engine workflows.
Expertise in Claim Definitions (CDF), Claim Logic Rules, 837P EDI formatting, and claim edit workqueue configuration.
Extensive experience with EDI standards, specifically 276/277 claim statusing, 837P claim generation, and 835 payment remittance integration.
Bachelor's degree in Healthcare Information Systems, Computer Science, Business Administration, or equivalent relevant experience.

Nice To Haves

Additional or dual certification in Epic Resolute Professional Billing (PB) Administration or Epic Charge Router.
Experience with healthcare clearinghouses such as Change Healthcare, Experian Health, Waystar, or Availity.
Background in Single Billing Office (SBO) workflows and integration with Hospital Billing (HB) and Cadence scheduling.
Proficiency with SQL, Epic Reporting Workbench, or Radar Dashboards to monitor claims throughput and workqueue health.

Responsibilities

Build and configure automated claim statusing workflows using ANSI ASC X12 EDI transactions (276/277), including clearinghouse integration, 999/277CA acknowledgment ingestion, and payer statusing bridges.
Construct and refine Account and Claim Status Workqueues with automated routing; analyze lag times and payer response trends to reduce Days in A/R.
Configure and maintain Claims build, Claim Definition files (CDF), payer output formats (CMS-1500 / 837P), claim edit rules, and validation criteria to improve first-pass clean claim rates.
Manage payer ID mapping, provider credentialing mapping and overrides, taxonomy crosswalks, and Revenue Module Object (RMO) billing rules.
Conduct unit, integrated, and end-to-end testing for new claims build, system upgrades, and annual regulatory and payer updates.
Partner with billing and Revenue Integrity teams to analyze pre-bill edits, clearinghouse rejections, and post-submission denials; troubleshoot claims interface and EDI engine issues.