Senior EPIC PB / Claims Analyst III - Hybrid

San Ysidro Health CenterSan Diego, CA, United States

4 days ago

Job type

Full-time

Job description

Position Summary :

The IT Senior Epic PB / Claims Analyst III is responsible for supporting and optimizing the integration between Epic's claims processing system and various other internal systems. This role focuses on ensuring that claims are processed smoothly, troubleshooting technical issues, and configuring Epic's claims-related functionality to improve billing operations. The ideal candidate will have expertise in Epic's Claims module, experience with healthcare IT systems, and a strong understanding of the revenue cycle process.

To be considered for this role, candidates must either currently live in California or demonstrate a willingness to relocate prior to employment.

Essential Functions of the Job :

Epic Claims System Support :

Support, configure, and maintain Epic's Claims and Professional Billing (PB) modules.
Collaborate with IT, revenue cycle, and business teams to configure and optimize the Epic system to ensure proper claims processing.
Troubleshoot system issues related to claims processing and work with Epic support to resolve them.

Integration and Interface Management :

Work with cross-functional teams to integrate Epic's claims processing with other internal systems (e.g., financial systems, payer portals).

Ensure data integrity and proper workflow between Epic and external payer systems.

Technical Analysis and Troubleshooting :

Analyze and resolve technical issues affecting claims submission, status tracking, denials, and reimbursements.

Act as a liaison between the IT and revenue cycle teams to ensure seamless communication and issue resolution.

Data and Reporting :

Develop and run reports from Epic's claims module to track claim status, aging, denials, and other key performance indicators.

Provide technical support for claims data analysis, helping the revenue cycle team identify trends and areas for improvement.

System Enhancements and Upgrades :

Assist in system upgrades, patches, and configuration changes related to Epic's claims processing system.

Identify and implement process improvements to streamline claims workflows and increase efficiency.

Documentation :

Develop and maintain user documentation, system workflows, and technical procedures.

Additional Duties and Responsibilities :

Will be required to follow IT Change Control processes, create support documentation following standard protocols and have working knowledge of HIPAA and other IT security and privacy best practices

Adheres to all applicable SYHealth policies, procedures, protocols, and best practices

Demonstrates effective verbal and written communication skills in collaboration with teams to achieve quality, excellence, harmony and problem-solving to obtain stated goals and objectives

Demonstrates active listening skills, respect and a positive "Can Do" attitude

Enhances professional growth and development through participation in educational programs, reading literature to keep up-to-date related to healthcare laws and Leadership, attending in-service trainings and workshops to improve upon knowledge and skillset

Attends meetings, as required, and participates on committees, as directed

Demonstrates professional behavior standard etiquette, courtesy, mutual respect, confidentiality and treats every patient and employee with dignity in every interaction

Exhibits a high level of integrity, ethics, transparency, leadership style and trust

Promotes and fosters respect for patient privacy by maintaining confidentiality on all patient EHR data and abides by both the HIPAA Privacy and Security rules

Exhibits excellent presentation skills, confidently speaks up, follows the appropriate chain of command and demonstrates effective verbal and written communication skills

Maintains a clean, safe and organized work area at all times.

Performs any other job-related duties as needed, assigned, or requested

Job Requirements

Experience Required :

10+ years of experience working with Epic Claims or Epic Professional Billing (PB) modules.

Experience in healthcare IT systems, revenue cycle management, or claims processing.

Education Required :

High School diploma or equivalent required

Certifications Required :

Relevant certifications (Epic Claims, Epic PB, etc.)

Verbal and Written Skills Required to Perform the Job :

Strong written and verbal communication skills

Strong facilitation and presentation skills

Think abstractly beyond basic data requirement

Communicate in a clear and concise manner, verbally and in writing

Communicate effectively and partner with senior level staff to determine business goals and objectives, and ways to partner in order to achieve those objectives

Exercise strong planning, organizing, and communication skills

Technical Knowledge and Skills Required to Perform the Job :

Strong technical knowledge of Epic's Claims and PB modules.

Knowledge of healthcare billing, payer requirements, and insurance claim processing

Familiarity with healthcare IT systems, including interfaces and integrations.

Excellent problem-solving and analytical skills.

Ability to work with both technical and non-technical stakeholders to resolve system issues.

Strong communication and interpersonal skills.

Knowledge of SQL or other query languages is a plus.

Equipment Used :

Personal Computer, Office Equipment

Working Conditions and Physical Requirements :

Flexibility in schedule to meet project deadlines

Sitting for extended periods of time

Sufficient dexterity to effectively operate a computer keyboard and other related peripherals

Universal Requirements :

To be considered for this role, candidates must either currently live in California or demonstrate a willingness to relocate prior to employment. Pre-employment requirements include I-9, physical, positive background and reference check results, complete application, new hire orientation, pre-employment PPDs. Compliance with all mandated vaccinations and all boosters is a term and condition of employment.

About Us San Ysidro Health is a Federally Qualified Health Care organization committed to providing high quality, compassionate, accessible and affordable healthcare services for the entire family. The organization was founded by seven women in search of medical services for their families and community. Almost 50 years later, San Ysidro Health now provides innovative care to over 108,000 patients through a vast and integrated network of 47 program sites across the county. San Ysidro Health could not serve our patients without the dedication of our passionate and hardworking employees. Apply today and become a part of our mission-driven team! San Ysidro Health has a long-standing commitment to equal employment opportunity for all applicants for employment. Employment decisions including, but not limited to, those such as employee selection, performance evaluation, administration of benefits, working conditions, employee programs, transfers, position changes, training, disciplinary action, compensation, and separations are made without regard to race, color, religion (including religious dress and grooming), creed, national origin, nationality, citizenship status, domestic partnership status, ancestry, gender, affectional or sexual orientation, gender identity or expression, marital status, civil union status, family status, age, mental or physical disability (including AIDS or HIV-related status), atypical heredity cellular or blood trait of an individual, genetic information or refusal to submit to a genetic test or make available the results of a genetic test, military status, veteran status, or any other characteristic protected by applicable federal, state, or local laws.

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