HB/PB Claims Analyst

job summary:

Enterprise Healthcare client has an immediate opening for a highly motivated HB/PB Claims Analyst to join their dynamic and growing team. All qualified candidates are encouraged to apply!

location: Telecommute

job type: Contract

salary: $20.50 - 30.50 per hour

work hours: 8am to 5pm

education: Bachelors

responsibilities:

Position Summary:

The Epic Payors Contract Configuration Analyst is responsible for the loading, maintenance, and troubleshooting of all payor contracts for a dynamic health system. This role will perform payor contract builds ensuring quality and accuracy, manages contract build deficiencies, audits peer-created contract builds, and performs regularly scheduled quality checks and fee schedule upload maintenance.

The Epic Payors Contract Configuration Analyst collaborates with the Revenue Cycle Management team to address contract related build issues, and holds primary responsibility for the design, build, testing, validation, and ongoing support of the Epic contract management applications. The position requires deep knowledge of reimbursement methodologies of government payors, managed care commercial payors, software functionality and the revenue cycle workflows in Epic.

Key Responsibilities:

- Interpret Contract Terms: Partner with Director of Payor Solutions Compliance and the team to review and clarify contract language.

- Epic System Configuration: Design, build, validate, and support the Epic contract build in alignment with revenue cycle workflows.

- System Design & Validation: Participate in design and advanced validation sessions to ensure accurate contract build configuration.

- Testing & Documentation: Conduct structured application testing and maintain thorough documentation of results.

- Release Management: Review and test new builds and releases prior to production deployment.

- Resolve Contract Variances: Troubleshoot and correct discrepancies in contract builds to ensure accuracy and compliance.

- Manage Adjustments: Post contractual adjustments promptly and maintain weekly updates on outstanding items and build deficiencies.

- Issue Management: Track, update, and resolve contract build issues efficiently.

- Training Development: Collaborate with team during peer reviews to establish new workflows as necessary.

- Technical Support: Troubleshoot contract build related problems reported by Revenue Cycle Management team as end-users.

- Continuous Improvement: Identify and recommend contract build enhancements to optimize performance.

Qualifications:

- Education: Bachelors degree in Health Information Management, Healthcare Administration, Computer Science, or a related field preferred.

- Epic Certification in Contract Management or related module(s) for hospital and professional.

- Experience: Minimum of 5 years of experience working with Epic systems, specifically in Contract management or similar roles.

- Skills:

- Must have the ability to analyze complex data, identify trends, and draw actionable insights to optimize contract performance.

- Must have a strong understanding of healthcare contracts, including terms, billing codes (CPT, HCPCS, MSDRG, APC, ICD-10, etc.), & government reimbursement methodologies.

- Excellent communication abilities.

Working Conditions:

- Hybrid or on-site work environment depending on organizational policy.

qualifications:

Bachelors

skills:

in design,application testing,Epic System,Health Information Management,Computer Science,Release Management,production deployment,communication abilities,Troubleshoot,audits,Continuous Improvement,contract management,contract language,thorough documentation,Epic Certification,contract performance,HCPCS,Healthcare Administration,healthcare,ICD-10,Issue Management,maintenance,managed care,reimbursement methodologies,billing codes,quality checks,Revenue Cycle Management,revenue cycle,System Design,Technical Support,testing,Training Development,identify trends,workflows

Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.

At Randstad Digital, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact


Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad Digital offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).

This posting is open for thirty (30) days.

It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.