Epic Revenue Cycle Analyst – PB Contracting, Claims, and Remittance

Computer Task Group, Inc•UNAVAILABLE, UNAVAILABLE

3h•Remote

About The Position

The Epic Proration and Contracting Analyst acts as the primary architect bridging healthcare finance and clinical configuration. This technical role is responsible for translating complex legal payer contracts, fee structures, and regulatory reimbursement policies into highly precise system automation within Epic Resolute Professional Billing (PB). By designing, testing, and maintaining contract portfolios and configuring outbound claims and inbound electronic remittance automation, this position maximizes cash flow, eliminates zero-balance blind spots, and engineers systemic solutions to automatically catch and mitigate insurance underpayments and denials.

Requirements

Epic Core Application Build (PB)
Proficient in configuring and linking Contract (CPD), Fee Schedule (FSC), and Procedure (EAP) master files.
Mastery of configuring dynamic pre-claim proration to split complex financial liabilities between Payer Allowance and Patient Responsibility (copay, coinsurance, deductible).
Deep understanding of Epic Charge Router mechanisms to ensure accurate charge flows from clinical applications (EpicCare, OpTime) into the PB engine.
Expertise in writing Lessor-Of logic comparing billed charges against allowable rates to calculate precise expected reimbursement values.
Thorough knowledge of electronic data interchange processing and technical layout configurations.
Expert capability in mapping and formatting professional billing charges into compliant ANSI X12 837P data streams.
Advanced configuration of Electronic Remittance Advice (ERA) parsing and automated posting logic.
Specialized skill in mapping Claim Adjustment Reason Codes and Remittance Advice Remark Codes to drive automated billing actions.
Advanced design of variance tolerance thresholds to identify discrepancies where Payer Allowed Amounts fall below Epic Expected Reimbursement.
Mastery in writing complex, context-specific CER and PAF criteria to identify contract violations and isolate root-cause denials.
Experience structuring specialized Contract Variance and Remittance Follow-Up Workqueues to segregate financial disputes from daily billing operational queues.
Implementation of single-click automated Follow-Up Activities to package dispute letters and appeal documentation directly from the user workspace.
Proven track record of executing mock 835 cycles in Sandbox/Test (TST) environments to validate newly built contract portfolios prior to Production (PRD) deployment.
Ability to run targeted audits on Chronicles data, identifying systemic payer patterns regarding underpayments and claim rejections.
Excellent verbal and written English communication skills.
Ability to interact professionally with a diverse group.

Responsibilities

Designing, testing, and maintaining contract portfolios within Epic Resolute Professional Billing (PB).
Configuring outbound claims and inbound electronic remittance automation.
Maximizing cash flow and eliminating zero-balance blind spots.
Engineering systemic solutions to automatically catch and mitigate insurance underpayments and denials.
Proficiently configuring and linking Epic Master Files: Contract (CPD), Fee Schedule (FSC), and Procedure (EAP).
Mastering the configuration of dynamic pre-claim proration to split financial liabilities between Payer Allowance and Patient Responsibility.
Ensuring accurate charge flows from clinical applications into the PB engine via Epic Charge Router mechanisms.
Writing Lessor-Of logic to compare billed charges against allowable rates for precise reimbursement values.
Mapping and formatting professional billing charges into compliant ANSI X12 837P data streams.
Advanced configuration of Electronic Remittance Advice (ERA) parsing and automated posting logic.
Mapping Claim Adjustment Reason Codes and Remittance Advice Remark Codes to drive automated billing actions.
Designing variance tolerance thresholds to identify discrepancies where Payer Allowed Amounts fall below Epic Expected Reimbursement.
Writing complex, context-specific CER and PAF criteria to identify contract violations and isolate root-cause denials.
Structuring specialized Contract Variance and Remittance Follow-Up Workqueues.
Implementing single-click automated Follow-Up Activities to package dispute letters and appeal documentation.
Executing mock 835 cycles in Sandbox/Test (TST) environments to validate contract portfolios.
Running targeted audits on Chronicles data to identify systemic payer patterns regarding underpayments and claim rejections.