Benefit Analyst - Epic Tapestry Configuration

Job Description

We are seeking a Benefit Analyst with strong technical expertise to join our Business Operations team . This role focuses on translating complex Evidence of Coverage (EOC) documents into precise Epic Tapestry benefit configurations , ensuring accurate member cost shares, accumulators, and benefit limits. The analyst will collaborate closely with IT Application Analysts to implement new benefits, configuration changes, and system corrections with a high degree of accuracy and compliance.

Key Technical Responsibilities

• Interpret and analyze EOCs across multiple health plans and convert requirements into Epic Tapestry configuration .
• Configure and map benefit plans for diverse products (HMO, POS, Medi-Cal, Medicare, Exchange).
• Align CPT, HCPCS, REV, ICD-10 codes to benefit categories and validate coding logic.
• Analyze authorization rules and Division of Financial Responsibility (DOFR) for accurate system setup.
• Perform QA and validation of benefit configurations, including accumulators and cost-share logic.
• Execute system testing for new benefits and complex configuration changes within claims processing workflows.
• Investigate and resolve pending claims caused by configuration issues; adjudicate claims and apply corrective adjustments.
• Collaborate with IT to troubleshoot configuration errors, submit fixes, and document outcomes.
• Maintain benefit configuration standards, policies, and procedures; recommend process improvements for scalability.
• Conduct workflow analysis and consult on process optimization for new functionality and system upgrades.
• Partner with IT, Enrollment, Claims, and Contracting teams to ensure benefit accuracy and regulatory compliance.

Technical Requirements

Preferred Skills