Job Summary

We are seeking an experienced
Epic Revenue Cycle Claims Subject Matter Expert (SME)
to support a large-scale healthcare technology initiative. This consultant will provide deep expertise in Epic Revenue Cycle claims management processes, with a particular focus on claims generation, claim edits, claim reconciliation, and complex claim splitting workflows.

The ideal candidate is a highly skilled Epic Revenue Cycle professional with extensive experience resolving claims-related challenges, optimizing claims workflows, and supporting healthcare organizations through revenue cycle transformation and operational improvement initiatives.

Assignment Details:

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  Initial 6-month contract with likelihood of extensions
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  Fully remote
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  Immediate need for an experienced claims expert
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  Opportunity to support a large healthcare organization through critical revenue cycle initiatives

Key Responsibilities

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  Serve as the primary subject matter expert for Epic Revenue Cycle claims workflows and processes.
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  Analyze existing claims processes and identify opportunities for optimization and improved reimbursement outcomes.
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  Provide expertise in complex claims management, including claim splitting, claim edits, billing workflows, and claims resolution.
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  Support the design, configuration, validation, and optimization of Epic Revenue Cycle functionality related to claims processing.
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  Partner with revenue cycle leadership, billing teams, operational stakeholders, and technical teams to address claims challenges and system enhancements.
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  Investigate, troubleshoot, and resolve claims processing issues, denials, edits, and workflow inefficiencies.
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  Review claims data, identify root causes of issues, and recommend corrective actions.
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  Support testing activities, including unit testing, integrated testing, user acceptance testing, and workflow validation.
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  Develop and maintain documentation for claims workflows, business requirements, configurations, and process improvements.
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  Provide guidance and best practices related to claims management, reimbursement workflows, and revenue cycle operations.
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  Assist with go-live support, stabilization efforts, and post-implementation optimization activities.

Required Qualifications

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  Minimum of 5 years of Epic Revenue Cycle experience.
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  Extensive hands-on experience with Epic claims management and billing workflows.
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  Deep expertise in claim splitting, claim edits, claims reconciliation, and claims processing operations.
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  Strong understanding of healthcare reimbursement methodologies and revenue cycle best practices.
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  Experience identifying and resolving denials, billing issues, and revenue cycle workflow challenges.
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  Experience gathering requirements and translating operational needs into system solutions.
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  Strong analytical, troubleshooting, and problem-solving skills.
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  Excellent communication and stakeholder management abilities.
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  Experience working with large healthcare organizations and complex revenue cycle environments.

Preferred Qualifications

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  Epic Resolute Hospital Billing (HB) and/or Professional Billing (PB) Certification.
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  Epic Claims Certification preferred.
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  Experience supporting Epic implementations, upgrades, optimizations, or revenue cycle transformation initiatives.
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  Experience with revenue integrity, denial management, and reimbursement optimization.
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  Consulting experience preferred.
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  Experience supporting enterprise healthcare systems with high claims volume.