Overview:
Position Summary:
The Epic Tapestry Analyst - Health Plan AP Claims is responsible for supporting the build, configuration, maintenance, and optimization of Epic's Tapestry module, with a specialized focus on the Health Plan Accounts Payable (AP) Claims functionality. This role ensures the integrity and efficiency of claims processing, vendor payments, adjudication logic, and integration with financial systems within a health plan environment.
Key Responsibilities:
* Configure, analyze, and maintain Epic Tapestry modules related to Health Plan Claims and AP processes.
* Support end-to-end AP claims workflows including claims intake, adjudication, payment processing, and remittance advice.
* Collaborate with business stakeholders to gather and validate requirements, ensuring system configuration aligns with operational needs.
* Identify, troubleshoot, and resolve system issues related to Tapestry claims processing and financial transactions.
* Develop and maintain technical documentation, process flows, test scripts, and standard operating procedures.
* Perform system testing for upgrades, new implementations, and enhancement releases, including integration testing with external vendor systems and financial platforms.
* Participate in project teams for Epic Tapestry enhancements, claims system upgrades, and integration initiatives.
* Monitor system performance and proactively address potential issues impacting claims operations or AP workflows.
* Partner with Finance, Claims, and Provider Relations teams to ensure accuracy and compliance in claims adjudication and payment.
Required Qualifications:
* Bachelor's degree in Information Systems, Healthcare Administration, Business, or related field (or equivalent experience).
* Minimum 3 years of hands-on experience with Epic Tapestry, particularly in Claims and AP (Accounts Payable) functionality.
* Active Epic Tapestry Certification (or ability to obtain certification within a defined timeframe).
* Strong understanding of healthcare claims processing, CMS requirements, HIPAA, and managed care operations.
* Experience working in a health plan or payer environment with knowledge of claims lifecycle and provider payment methodologies.
* Demonstrated experience with SQL or reporting tools for data validation and analysis.
Preferred Qualifications:
* Experience with cross-functional teams including finance, enrollment, provider contracting, and EDI.
* Knowledge of integration points between Epic Tapestry and third-party applications or payment systems (e.g., banks, accounting software).
* Familiarity with Capitation, Fee-for-Service, and Value-Based Payment models.
* Exposure to CMS encounter data submissions and regulatory compliance processes.
Core Competencies:
* Analytical thinking and attention to detail
* Strong communication and interpersonal skills
* Ability to manage multiple priorities in a fast-paced environment
* Customer service orientation with a problem-solving mindset
* Collaborative team player with the ability to work independently
Responsibilities:
With a high degree of latitude, the Systems Analyst 4 reviews business requirements, analyzes and evaluates existing and/or proposed systems and designs and develops IT system solutions in response. This role participates in and leads teams through work efforts which may include configuration, implementation of and on-going maintenance and support for production application systems with broad impact. Participates in identification and prioritization of work efforts with leaders and/or stakeholders.
* Build, configure, and program applications to meet user requirements for new and optimized workflows in designated software applications and systems.
* Implements new software applications and systems, performs upgrades consistent with project plan(s), technical specifications, and operations requirements of the health system. Provide proactive remediation of potential issues.
* Identify and diagnose issues that arise in the supported application area as well as issues that impact other application teams, and work to resolve them. Assess severity of issues and prioritize responses as appropriate.
* Tests and validates software applications and systems to ensure proper operation, implementation of software design and end-user acceptance
* Analyzes clinical or operational workflows supported by the assigned products and their relationship to the technical environment in which they operate.
* Assist in developing project plans and details. Apply principles of Project Management (may include but not limited to: project schedules, agile principles, budget and status reports) to accomplish project objectives.
* Ensures documentation is provided for support, end user training and testing/validation. May provide implementation support with end users.
* Follows established protocols in the execution of all activities to ensure the safety and security of information system assets, processes, and data.
* Possesses expert knowledge in impacted areas. Handles the most complex issues and problems across multiple platforms.
* Coaches and leads others in acquiring knowledge and provides expert advice. May serve as an evaluator of staff within the team. Provides leadership, coaching and/or mentoring to a subordinate group; may act as a "lead" or supervisor.
* Perform other duties and responsibilities as assigned.
Qualifications:
* Education: Bachelors degree or experience in lieu of degree
* Experience: 6 years relevant experience.
* Licenses/Certifications: None
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