Epic Tapestry Claims Analyst

WHAT : Tapestry Analyst WHEN : ASAP, Full-Time, 6-12-month Contract with likelihood of extension and/or conversion WHERE : Remote, CST Hours SUMMARY : The Tapestry Managed Care Analyst is a specialized consulting role focused on maximizing the value and performance of our client's existing Epic Tapestry environment. This individual leverages deep technical and operational expertise to drive optimization across key payer functions, including AP Contracts and Claims processing. KEY RESPONSIBILITIES : Managed Care Configuration : Perform expert-level analysis, design, build, and testing within the core Tapestry modules, focusing on Benefits Engine (EBN), Contracts Administration (HPL), Claims Administration (AP Claims), and Referral/Authorization (UM). Claims Edit Logic : Directly configure and maintain complex claims edits, including the creation of Claims CEVs (Claim Edit Voids), and optimize the workflow for claim suspense, resolution, and payment integrity. External System Integration : Maintain and optimize integration points with third-party claims editing and pricing software, specifically Optum CES and Optum PPS, ensuring accurate real-time data exchange. Repricer Workflow : Design, implement, and troubleshoot the end-to-end repricer workflow within Epic Tapestry to ensure accurate claim pricing based on complex, networked contract rules and regulatory requirements. Design and test complex import/export interfaces for external Epic integrations (e.g., 837, 835, 277 EDI transactions). Assist with the design and execution of data migration strategies, including the use of Epic's FDI (Foundation Data Integration) records and other complex import/export tools. KEY REQUIREMENTS : Experience creating claims CEVs. 3+ years of experience with Repricer workflow in Epic. Understanding of complex/networked rule logic, ideally in the AP Claims context. Experience with complex import/exports in Epic, FDI records, other external Epic integrations. Preferred certification in Epic Tapestry (Managed Care, Claims, Contracts, or similar). 4+ years of hands-on experience in Epic Tapestry configuration, with a focus on AP Claims and Managed Care workflows. 2+ years of direct working experience with claims editing/pricing software integration, specifically Optum CES and/or PPS, and managing the Epic repricer workflow. Proven experience with advanced Epic integration tools, including FDI records and complex import/export file configurations for data conversion and interfacing. 2+ years of working with Tapestry at a Health Plan. Job Details

Seniority level: Mid-Senior level Employment type: Contract Job function: Analyst Industries: Hospitals and Health Care

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