Hill Physicians Medical Group
Benefit Analyst Epic Tapestry Configuration (San Ramon)
Hill Physicians Medical Group, San Ramon, California, United States, 94583
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 5+ years
in benefit configuration and claims within Managed Care or delegated model. Hands-on experience with
Epic Tapestry
(preferred). Strong knowledge of
medical coding
(CPT, HCPCS, REV, ICD-10) and claims adjudication logic. Familiarity with
CMS mandates, NCDs, LCDs , and regulatory requirements for multiple plan types. Proficiency in
Excel (VLOOKUP, Pivot Tables)
and
Microsoft 365 ; experience with
data validation and QA testing . Certified Medical Coder (preferred) or equivalent coding expertise. Strong analytical and documentation skills; ability to work independently in a fast-paced environment. Preferred Skills Experience with
benefit mapping ,
system integration , and
claims workflow optimization . Knowledge of
cost-share accumulators , out-of-pocket maximums, and benefit limit logic. Familiarity with
testing frameworks
and
QA methodologies
for healthcare systems
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 5+ years
in benefit configuration and claims within Managed Care or delegated model. Hands-on experience with
Epic Tapestry
(preferred). Strong knowledge of
medical coding
(CPT, HCPCS, REV, ICD-10) and claims adjudication logic. Familiarity with
CMS mandates, NCDs, LCDs , and regulatory requirements for multiple plan types. Proficiency in
Excel (VLOOKUP, Pivot Tables)
and
Microsoft 365 ; experience with
data validation and QA testing . Certified Medical Coder (preferred) or equivalent coding expertise. Strong analytical and documentation skills; ability to work independently in a fast-paced environment. Preferred Skills Experience with
benefit mapping ,
system integration , and
claims workflow optimization . Knowledge of
cost-share accumulators , out-of-pocket maximums, and benefit limit logic. Familiarity with
testing frameworks
and
QA methodologies
for healthcare systems