EPIC EMR/EHR consultant - Professional Billing PB

KēSTA I.T.•Jackson, MS

8d•Hybrid

About The Position

We Are Seeking an experienced Patient Benefits Analyst to support revenue cycle operations through insurance coverage verification, benefits analysis, patient responsibility review, and revenue optimization initiatives. This role serves as a key liaison between clinical operations, revenue cycle teams, and leadership by ensuring accurate insurance coverage documentation, identifying reimbursement opportunities, analyzing trends, and recommending process improvements that enhance revenue collection and operational efficiency. The ideal candidate will possess strong healthcare revenue cycle expertise, Epic experience, insurance benefit interpretation knowledge, and the ability to translate data into actionable recommendations.

Requirements

Bachelor's degree in Healthcare Administration, Health Information Management, Business Administration, or a related field.
Strong experience with Epic Professional Billing (PB); Epic certification preferred.
RHIA, RHIT, CPC, or equivalent healthcare certification required.
Advanced knowledge of healthcare revenue cycle operations, claims processing, and reimbursement methodologies.
Experience with revenue cycle reporting, system build, business logic, claims adjudication, and data analysis.
Strong understanding of insurance benefit interpretation, eligibility verification, and patient responsibility calculations.
Experience working with healthcare clearinghouses and payer systems.
Expertise in third-party coverage discovery processes and insurance verification workflows.
Ability to interpret Real-Time Eligibility (RTE) responses and insurance coverage information.
Strong analytical, problem-solving, and process improvement skills.
Experience identifying trends and developing recommendations to improve financial performance.
Excellent verbal and written communication skills with the ability to work effectively with clinical, operational, and executive stakeholders.
Ability to manage multiple priorities while maintaining accuracy and attention to detail.
Strong organizational skills and ability to work independently in a collaborative healthcare environment.

Nice To Haves

Experience supporting training, documentation, and operational readiness initiatives is highly desirable.
Familiarity with healthcare compliance, reimbursement regulations, and revenue cycle best practices is preferred.

Responsibilities

Review insurance coverage discovery results for scheduled patient appointments and determine patient financial responsibility.
Document insurance coverage, benefits information, and patient responsibility accurately within Epic.
Analyze coverage discovery outcomes and identify trends impacting patient responsibility collections and reimbursement.
Monitor and evaluate revenue cycle performance metrics related to insurance coverage and patient collections.
Identify opportunities to improve collection rates for patient responsibility balances and third-party payer reimbursements.
Recommend process improvements that optimize revenue cycle workflows and financial performance.
Communicate findings, trends, and recommendations to operational and clinical leadership.
Collaborate with revenue cycle, registration, billing, and clinical teams to address coverage-related issues.
Interpret real-time eligibility (RTE) responses and insurance benefit information to support accurate patient account processing.
Work with clearinghouses and payer systems to research coverage discrepancies and eligibility concerns.
Assist with reporting, data analysis, training, and documentation related to revenue cycle operations.
Support compliance with organizational policies, payer requirements, and healthcare industry best practices.
Maintain accurate records, reports, and supporting documentation for revenue cycle activities.
Participate in process improvement initiatives designed to enhance patient access, reimbursement accuracy, and operational effectiveness.