Epic Revenue Cycle Analyst

Quoris, LLC•Philadelphia, PA

1d•Hybrid

About The Position

We are seeking a Senior Epic Revenue Cycle Analyst to serve as the Epic subject matter expert for an enterprise AI and analytics platform focused on revenue cycle use cases. Phase 1 centers on prior authorization and denial management, with the analyst connecting how work flows through Epic to the data, rules, and outcomes the platform depends on. The Epic Revenue Cycle Analyst will serve as the primary Epic revenue cycle authority responsible for documenting, optimizing, and translating front-end and back-end revenue cycle workflows into clear data requirements for an enterprise analytics and AI platform. This individual will bring deep hands-on expertise across Cadence, Prelude, Resolute HB, and Resolute PB, with primary emphasis on prior authorization workflows, denial management, and end-to-end revenue cycle operations. The ideal candidate can operate fluently between revenue cycle operations and technical engineering teams, translating Epic workflows into data logic and translating technical constraints back into operational terms.

Requirements

Current Epic certification in all four of the following: Resolute Hospital Billing, Resolute Professional Billing, Cadence, and Prelude — active or eligible for reactivation.
7+ years of hands-on Epic revenue cycle experience in a hospital or health system setting with production build, optimization, or support responsibility.
Hands-on depth across Cadence, Prelude, Resolute Hospital Billing, and Resolute Professional Billing including Single Billing Office environments.
Demonstrated experience designing or optimizing prior authorization workflows in Epic with measurable outcomes.
Demonstrated experience designing or optimizing denial management and appeals workflows in Epic.
Working knowledge of payer authorization requirements, EDI X12 transactions (270/271, 278, 835, 837), CARC/RARC codes, and payer contract concepts.
Experience working within formal Epic change control processes including change requests, impact analysis, environment migration, and post-release validation.
Ability to travel up to 20% as required.
Must be eligible to work in the U.S. without company sponsorship.

Nice To Haves

Epic revenue cycle write-back experience connecting external analytics or AI platform outputs into Epic via FHIR, web services, or inbound HL7 interfaces.
10+ years of total revenue cycle experience including operational experience in patient access, coding, billing, or follow-up.
Academic medical center experience.
Experience supporting analytics, automation, or AI initiatives in revenue cycle.
Familiarity with Epic Clarity or Caboodle data structures for revenue cycle reporting.
Epic Referrals certification strongly preferred given the prior authorization focus.
Epic Claims and Remittance, Grand Central, or additional revenue cycle certifications.
NAHAM CHAM or CHAA, HFMA CRCR or CRCP, or AHIMA/AAPC coding credential.

Responsibilities

Serve as the lead Epic subject matter expert for front-end prior authorization from order entry and scheduling through registration, eligibility, authorization, and date of service.
Document and optimize current-state workflows across Cadence, Prelude, and Epic referral and authorization records including order-to-schedule handoffs, authorization workqueues, and scheduling rules.
Identify where authorization requirements are detected and design workflows that surface them as early as possible.
Improve registration quality in Prelude including coverage selection, coordination of benefits, and eligibility verification to prevent downstream denials.
Define requirements for real-time eligibility (270/271) and electronic prior authorization (278) transactions and their mapping to Epic coverage, referral, and authorization records.
Trace authorization-related denials back to the specific scheduling, registration, or authorization step that caused them.
Define front-end performance measures including authorization turnaround time, authorization-related denial rate, and percentage of authorizations secured before date of service.
Analyze denial patterns across HB and PB by payer, denial reason, CARC/RARC code, service line, and root cause.
Document and optimize Epic denial workflows including remittance-driven denial routing, follow-up and denial workqueues, and appeal letter templates.
Map denial categories to upstream root causes in scheduling, registration, eligibility, authorization, coding, and charge capture.
Define denial and appeal outcome logic that the AI platform will use for prioritization and prediction.
Serve as the Epic revenue cycle authority across patient access, charge capture, coding handoffs, claim creation and edits, remittance posting, follow-up, and patient billing.
Translate HB and PB workflows into clear data requirements for 835 and 837 transactions, Clarity and Caboodle reporting, and the platform's core data objects.
Validate platform outputs against Epic source-of-truth data and operational reality before results reach end users.
Define requirements for writing platform outputs back into Epic including target records, workqueue routing, user-facing display, and audit trail.
Own change control for Epic revenue cycle workflow and build changes tied to the program from change request through post-implementation validation.
Document each proposed change with business rationale, impact analysis across HB, PB, patient access, and interfaces, and a rollback plan.
Route changes through Epic governance and change advisory processes and track approvals, build migration, and release timing.
Plan and support unit, integrated, and user acceptance testing for every workflow change and confirm results before production release.