Technical Specialist- Expert HB PB Claims Analyst

1 month ago

Raleigh, United States HighCloud Solutions Full time
Title Technical Specialist Expert (HB PB Claims Analyst) Location Remote Duration 5 Months Interview Type Webcam Interview Only Job Type C2CW2 Job Description

NCDHHS is a seeking an experienced Epic PB HB and Claims Analyst.

Competency Model:

Business Acumen

  • Understands the organizations strategic goals and how department goals support the organization.
  • Seeks opportunities to extend and deepen learning of organization and area.
  • Shares new information and knowledge with others.
  • Be curious; question your assumptions when presented with an issue or question.
  • Selfmotivated to research and learn new information and explore new options.
  • Seeks to maximize potential abilities and helps others.
  • Follow instructions written or oral.
  • Adhere to all scheduling and attendance requirements.
  • Honesty truthfulness reliability accountability
  • Read understand and apply regulations and policies.
  • Knowledge of relevant privacy regulations such as The Privacy Act Freedom of Information Act and HIPPA law
  • Knowledge of revenue cycle billing hospital billing professional billing and claims processing operations and workflows
  • Knowledge and understanding of thirdparty applications.
  • Establishes professional working relationships.
  • Communicates verbally with team departments guests and management.

Communication

  • Expresses oneself clearly in conversations business writing and interactions with others.
  • Delivers oral and written communications that are impactful and persuasive to their intended audiences.
  • Demonstrates a high level of emotional intelligence in the face of conflict.
  • Responds to tickets and emails in a timely manner.

Planning and Organizing

  • Manages and monitors time and resources effectively to complete assignments.
  • Utilizes resources and gets involvement from others where appropriate.
  • Shares information materials and time readily with others who need them

Teamwork

  • Encourages participation from all team members regardless of role within organization; supports team members and customers.
  • Identifies and works through conflict that may derail the collaborative process.
  • Holds self and others accountable to create unifying goals and measure with peers.
  • Support NCDHHS analyst team through knowledge sharing and concise documentation.
  • Applies the knowledge of fundamental IT concepts.
  • Asks questions diligently seeks and is receptive of guidance.

Drive Change

  • Anticipates potential concerns/resistance to change and takes constructive steps to address them.
  • Encourages others to adopt new methods or technologies that add value or improve performance.
  • Keeps others focused on critical goals and deadlines through periods of change or ambiguity.
  • Be flexible and adopt new processes and methods.
  • Stay positive in attitude and actions.

Working Conditions:

Essential:

  • May be required to work after hours or on weekends as needed
  • Infrequent travel
  • Pass preemployment drug test

Experience:

  • Must have strong leadership and communication skills with the ability to effectively present information to clinical and business leaders within the organization.
  • Must have experience with Epic PB HB and Claims. 8 years required.
  • Ability to work in small groups under tight project deadlines.
  • Working closely with business and revenue cycle leaders around Epic workflow and to translate business needs Epic billing functionality.
  • Must possess Epic certification Resolute PB HB and Claims.
  • Minimum of five years progressive revenue cycle/healthcare experience with demonstrated experience in Epic build.
  • Selfstarter with demonstrated teamwork & communication skills.
  • Excellent communication and collaboration skills.
  • Excellent verbal and written English communication skills and the ability to interact professionally with a diverse group are required.
  • Experience working with Third Party Vendors such as Experian Relay Health and Hyland OnBase.
  • Knowledge of revenue cycle billing hospital billing professional billing and claims processing operations and workflows
  • Rapid Retest
  • Payer/plan creation and maintenance
  • PLBs
  • Charge Router
  • Contracts
  • Behavioral Health
  • Long term care psychiatric billing
  • CMS IPF PPS billing regulations
  • Substance abuse billing IOP methadone dosing
  • Medicare exhaust billing
  • Nopay claims.
  • Claim splits/interim claims.
  • Cash Management
  • Selfpay remittance
  • Developing testing scripts

Responsibilities:

  • Analyzes documents and communicates business requirements for new system functionality and enhancements to existing functionality.
  • Test system changes to ensure that they meet business requirements and do not adversely impact other areas of the Epic system.
  • Acts as the primary support contact for the applications endusers.
  • Identifies issues that arise in their application areas and issues that impact other application teams and works to resolve them
  • Guides workflow design builds tests the system and analyzes other technical issues associated with Epic software
  • Identifies implements completes integrated testing and communicates requested changes to the Epic system
  • Works with Epic representatives and end users to ensure the system meets the organizations business needs regarding the project deliverables and timeline
  • Performs indepth analysis of current and future workflows data collection report details and other technical issues associated with the Epic EHR and designated thirdparty applications
  • Partners with quality operational and business leaders on system design and optimization to meet quality safety financial and efficiency needs
  • Collects requirements regarding potential system enhancements or new system implementation and prepares details of specifications needed; prioritizes and implements requested changes to the system.
  • Investigates standardization and process improvement opportunities by rounding within revenue cycle areas while making build decisions.
  • Validates that data is accurate and meets business requirements.
  • Completes integrated testing to test system changes in all Epic environments to ensure that they meet business requirements and do not adversely impact other areas of the system.
  • Troubleshoots and identifies root causes and documents problems of simple to medium complexity for assigned applications and systems.
  • Maintains data integrity and security for assigned applications and systems.
  • Develops system documentation as assigned per standards.
  • Develops communicationrelated education efforts for deployments upgrades optimizations and other system changes as assigned.
  • Stays current on Epic application releases and participates in upgrade planning and testing.
  • Participates in performance improvement activities to measure assess and improve the quality of assigned work area

Education:

Essential:

  • Bachelors degree or 8 years experience in directly related field

Credentials:

Essential:

  • Pass general background check
  • Epic module certification as assigned
  • Epic HB/PB Claims Certification

Skill Required / Desired Amount of Experience Must have strong leadership and communication skills with the ability to effectively present information to clinical and business leaders within the Required 3 Years Must have experience with Epic PB HB and Claims Required 8 Years Ability to work in small groups under tight project deadlines Required 3 Years Working closely with business and revenue cycle leaders around Epic workflow and to translate business needs Epic billing functionality Required 3 Years Must possess Epic certification Resolute PB HB and Claims Required Minimum of five years progressive revenue cycle/healthcare experience with demonstrated experience in Epic build Required 5 Years Selfstarter with demonstrated teamwork & communication skills Required 3 Years Excellent communication and collaboration skills Required 3 Years

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