Workforce type: remote

Work location: 1500 Duarte Rd/ Medical Center

Job Type: Full-time, Days

Pay Rate: $146,019.74 - $176,805.00 per year

Position Summary:

Lead Systems Analyst – Epic (City of Hope National Medical Center; Duarte, CA): Lead teams and projects to configure, test, and deploy the Epic Revenue Cycle software (Epic Resolute PB, Epic Resolute HB, claims and remittance, Single Billing Office (SBO), and Cogito Admin) according to decisions made by operational and technical Subject Matter Experts (SME). Lead analysts within a single work stream and lines of a project plan. Assist support personnel in locating and resolving problems with programs. Design systems and programs to meet business needs. Prepare specifications from which programs are developed and coded. Ensure programs meet standards and technical specifications and perform technical analysis and component delivery. Gather information from existing systems and analyze program and time requirements. Ensure completion and quality of deliverables assigned to the team, including, but not limited to, project plan, design documentation, build audits, testing plans and scripts, training curriculum, and activation plans. Support the project management office (PMO) with design documentation, build audits, testing plans and scripts, training curriculum, and activation plans. Ensure programs meet standards and technical specifications and perform technical analysis and component delivery. Participate in initiatives by gathering and analyzing information, preparing structured documentation, presenting findings, and troubleshooting as necessary. Complete assigned team tasks as documented in the work plan and report status of task completion to the assigned manager. Provide timely alerts about endangered milestones and deliverables. Develop and test SQL Clarity reports. Perform data analysis and assess data requirements for projects and business initiatives. Apply data extract strategies to maintain cardinality of revenue cycle data models. Apply technology and operational best practices in designing, developing, and implementing standards and capabilities. Conduct analysis, solve problems, and provide explanation and information on issues. Maintain knowledge of current domains and strategic roadmaps. Identify and quantify the scope and impact of business changes on systems. Incorporate software and system architecture into conceptual designs. Provide oversight of conceptual designs to ensure alignment with enterprise architecture governance (principles, policies, standards, and future-state reference architectures). Develop project plans, staffing requirements, resource assignments and mapping, assign and monitor tasks, create communication plans, monitor the scope schedule, and budget and create status reports and dashboards for the PMO. Work with end user clients to understand business needs. Perform maintenance tasks and mentor and develop analysts. Ensure claim submission is integrated with the external claims scrubber and maintained with the current payer and regulatory requirements. Develop, report, and utilize performance metrics to improve claims quality, operating efficiency, and outcomes. Develop workflows and processes for accurately reconciling claims submission between Epic and claims administrator. Act as the external claims administrator and upgrade and install patches and customize software. Develop, report, and utilize performance metrics to improve quality, operating efficiency, and outcomes. Use data to measure results against established pre-billing, claims, key performance indicators (KPI), and goals. Provide analysis of core KPIs, including submission, suspension, acceptance, 1st claim payment resolution rates, and denials. Perform claims reconciliation by monitoring released claims, total claim edits, rejections, and submission totals. Resolve and implement third-party tools as a layer over Epic (change health, assurance, banks, collection vendors, and third-party claim edit tools). Work with payer adjudication systems. Act as a SME regarding contract interpretation, variance reporting, and reimbursement analysis. Develop and maintain variance reports and perform analysis of payment variances from insurance payers. Provide ongoing maintenance to managed care contract terms related to insurance authorization, Treatment/Service Authorization Request (TAR/SAR), and the appeals process. Provide ongoing maintenance with the external interface partners. Stay current on insurance industry practices and governmental rules to make informed decisions about changes in reimbursement rates. Advise clients on workflows for claims, claims status response remittance, Medicare Direct Entry (DE), and remittance transactions. Identify and drive projects and changes in clinical modules to drive revenue cycle efficiencies. Drive clinically integrated revenue cycle workflows through Analytics. Telecommuting permitted from anywhere in the U.S.

Qualifications:

Minimum requirements: Bachelor's degree or foreign equivalent in Electronics Engineering, Computer Science, or related field, plus seven (7) years of experience as a Programmer Analyst, Software Engineer, or related occupation within the healthcare industry.

Must have experience with the following: leading multi-functional teams and projects with cross-functional participation; leading revenue cycle module implementation; planning and implementing Epic Resolute Billing modules and workflows to implement systems that meets business needs; working with stakeholders to identify business needs, define workflows, create business requirement documentation, design documentation, and translate designs into a build; creating dashboards for operational and strategic use; data analytics, including mining, generation and visualization, developing reports and dashboard using SQL, and other database tools within healthcare revenue cycle data models; leading teams and projects in Epic Resolute build and configuration; Epic Charge Router, Continuous Diagnostics and Mitigation (CDM), extracts, bed charge billing, cost center assignment, general ledger, master file exportsimports, chronicle searches, and reports and dashboards; claims build and master files: Benefit Plan Record (EPP), Enterprise Performance Management (EPM), Remittance Management Option (RMO), Electronic Claim Form (FDF), Claim Definition File (CDF) , and Payer Plan Build; Change Healthcare, ePREMIS, or claims administrator; administering and integrating third-party scrubber with Epic; Epic Revenue cycle data model and generating reports; developing and configuring interfaces between clearing houseExternal claim scrubber and Epic, configuring and maintaining bridge routines and Autolists in the external claim scrubber, and designing and configuring Cash Management and Cash Management interfaces between Epic and the Bank; configuring Epic Revenue cycle modules to meet requirements of insurance companies and regulatory laws; designing, developing, and maintaining the authorization workflow, TARSAR requirements, and the appeal process; ANSI X�1 EDI interchange format (transactions: 7, 7�1, 837P, 837I, 837D, 999, 76, 77 & 835) and implementing claims and remittance interfaces; and clinical and revenue cycle integration and assessing the impact of revenue cycle workflows on modules.