Epic Revenue Cycle Claims Subject Matter Expert (SME)

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:

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

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

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

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