Epic Resolute Professional Billing (PB) Analyst

Job title: Epic Resolute Professional Billing (PB) Analyst

Location: 100% Remote

Duration: 06+ Months with possibility of extension

Required Skills: Epic Resolute Professional Billing, Epic PB Administration, Charge Review, Charge Router, Work queues, Billing workflows, Charge capture, Claims editing

Focus Area: Epic Resolute Professional Billing (PB) / Revenue Cycle

Certification Required: Epic Resolute Professional Billing Admin Certification

Job Responsibilities:

We are seeking an experienced Epic Resolute Professional Billing (PB) resource to support a critical revenue cycle initiative involving the transition of Optum Claims Manager edits to Epic Charge Review edits and the clean-up and optimization of Epic Charge Router configuration.

The ideal candidate will have strong hands-on expertise in Epic Resolute Professional Billing, charge review workflows, charge router configuration, regulatory coding edits, work queues, and revenue cycle operations.

This individual will be expected to take ownership of the initiative, provide subject-matter expertise, identify workflow and configuration gaps, and lead efforts to improve charge edit management and billing accuracy.

Key Responsibilities:

• Lead and support the transition of Optum Claims Manager edits into Epic Charge Review edits.
• Review existing claims and billing edits and determine appropriate configuration within Epic.
• Analyze, validate, and implement regulatory and coding edits, including:
• LCD Local Coverage Determinations
• NCD National Coverage Determinations
• CCI/NCCI National Correct Coding Initiative
• MUE Medically Unlikely Edits
• Review existing Epic Charge Router configuration and identify outdated, redundant, incorrect, or unnecessary routing rules.
• Lead Charge Router clean-up and optimization activities.
• Evaluate charge routing logic to ensure charges are appropriately routed to the correct workqueues and downstream billing workflows.
• Review and optimize Epic Charge Review workqueues and associated workflows.
• Analyze charge edit volumes, trends, and error patterns to identify opportunities for process improvement.
• Partner with Professional Billing, HIM/Coding, Revenue Cycle, Compliance, Clinical, and IT/Epic teams to validate requirements and resolve issues.
• Translate business and regulatory requirements into appropriate Epic configuration and workflows.
• Troubleshoot charge-related issues and determine root causes related to charging, edits, routing, or workqueues configuration.
• Review existing Optum Claims Manager rules and map applicable edits to Epic functionality.
• Validate edit logic through testing and ensure appropriate outcomes before production implementation.
• Develop and execute test scenarios for charge review edits and charge routing changes.
• Support user acceptance testing (UAT), issue resolution, and implementation activities.
• Document configuration changes, workflows, decision logic, and testing results.
• Provide recommendations regarding edit maintenance, governance, and ongoing optimization.
• Monitor post-implementation results and make adjustments as necessary.
• Communicate project status, risks, issues, dependencies, and recommendations to project leadership.
• Serve as a subject-matter expert and provide guidance to other project team members.

Required Qualifications:

• Epic Resolute Professional Billing (PB) Admin certification is required.
• Strong hands-on experience with Epic Resolute Professional Billing.
• Demonstrated experience with Epic Charge Review functionality and workflows.
• Strong understanding of Epic Charge Router configuration and troubleshooting.
• Experience working with Epic workqueues (WQs) and revenue cycle workflows.
• Strong knowledge of healthcare billing and professional billing processes.
• Experience with regulatory and coding edits, including LCD, NCD, CCI/NCCI, and MUE.
• Experience transitioning or configuring claims-editing rules within an Epic environment.
• Ability to analyze existing edit logic and determine appropriate Epic configuration.
• Strong understanding of the relationship between charging, charge routing, charge review, coding, and billing.
• Experience with testing, validation, troubleshooting, and production implementation.
• Strong analytical and problem-solving skills.
• Ability to work independently and lead project activities with minimal supervision.

Preferred Qualifications:

• Experience with Optum Claims Manager or similar claims-editing platforms.
• Previous experience migrating or converting claims edits from a third-party claims-editing system into Epic.
• Experience with Epic Resolute PB charge router clean-up and optimization.
• Experience supporting large or complex healthcare organizations.
• Knowledge of professional billing regulatory requirements and payer-specific billing rules.
• Experience collaborating with Epic application teams, coding, compliance, HIM, and revenue cycle stakeholders.
• Strong documentation and project leadership skills.
• Epic implementation, optimization, or upgrade experience.