Epic Claims Analyst

Job Description: The Epic Billing Queue Management Technician is responsible for the daily monitoring, prioritization, and resolution of billing work queues within the Epic Resolute Hospital Billing (HB) applications. This position ensures that charges, claims, and account edits move efficiently through the revenue cycle by working claim edit, charge review, follow-up, and denial work queues in accordance with departmental productivity and quality standards. The Technician identifies error trends, escalates systemic issues, and collaborates with billing, coding, and IT teams to reduce queue volumes, minimize claim delays, and support timely, accurate reimbursement.

Job Requirements:

• High School Education/GED or equivalent: Required
• Two years experience of medical billing, claims processing, or revenue cycle experience: Required
• One year of hands-on experience working billing work queues in Epic Resolute (HB, PB, or both): Required
• Working knowledge of UB-04 and CMS-1500 claim forms, CPT, HCPCS, ICD-10, and revenue codes: Required
• Previous experience with commercial, Medicare, Medicaid, and managed care billing requirements: Required
• Previous experience with clearinghouse platforms (e.g., SSI) and payer portals (Availity, Waystar, Experian): Preferred
• Experience supporting work queue build, routing rules, or workflow redesign initiatives: Preferred

• State Pharmacy Technician license: Preferred
• Epic Resolute Hospital Billing certification, proficiency, or credentialed training: Preferred
• Certified Revenue Cycle Representative (CRCR), Certified Professional Biller (CPB), or comparable certification: Preferred
• Pharmaceutical Technician Board certification: Preferred
• Advanced certification (e.g., CHRI, CRCR, or 340B ACE): Preferred

Essential Functions:

• Monitor and work assigned Epic Pharmacy Med Charge HB work queues daily, including claim edit, charge review, charge router, follow-up, denial, and credit work queues, resolving accounts within established timeliness standards. Review and resolve claim edits and errors, ensuring claims meet payer, state, and federal billing requirements before release.
• Analyze accounts to identify root causes of edits and errors; correct patient, guarantor, coverage, and charge-level information as needed. Prioritize queue volumes based on dollar amount, timely filing deadlines, aging, and departmental direction.
• Identify recurring edit and error trends and escalate systemic issues to leadership, Epic application analysts, or payer representatives for resolution. Collaborate with coding, registration, clinical departments, and IT/Epic teams to resolve accounts requiring cross-functional input. Document all account activity clearly and accurately in Epic using appropriate account notes and activity codes.
• Recommend improvements to work queue rules, routing logic, and workflows to improve efficiency and reduce touches per account. Assist with testing of Epic upgrades, work queue changes, and new billing edits as requested. Meet or exceed established productivity and quality assurance standards.
• Maintain current knowledge of payer billing guidelines, regulatory requirements, and organizational policies. Protect patient privacy and confidentiality in accordance with HIPAA and organizational policy.
• Performs other job-related duties as assigned.