Epic Revenue Cycle Analyst – PB Contracting, Claims, and Remittance

CTG is seeking an experienced Revenue Cycle Analyst – PB Contracting, Claims, and Remittance. The Epic Proration and Contracting Analyst acts as the primary architect bridging healthcare finance and clinical configuration.

This technical role is responsible for translating complex legal payer contracts, fee structures, and regulatory reimbursement policies into highly precise system automation within Epic Resolute Professional Billing (PB). By designing, testing, and maintaining contract portfolios and configuring outbound claims and inbound electronic remittance automation, this position maximizes cash flow, eliminates zero-balance blind spots, and engineers systemic solutions to automatically catch and mitigate insurance underpayments and denials.

Skills Inventory

Epic Core Application Build (PB)

• Epic Master Files: Proficient in configuring and linking Contract (CPD), Fee Schedule (FSC), and Procedure (EAP) master files.
• Proration Logic: Mastery of configuring dynamic pre-claim proration to split complex financial liabilities between Payer Allowance and Patient Responsibility (copay, coinsurance, deductible).
• Charge Routing Integration: Deep understanding of Epic Charge Router mechanisms to ensure accurate charge flows from clinical applications (EpicCare, OpTime) into the PB engine.
• Lessor-Of Configuration: Expertise in writing logic comparing billed charges against allowable rates to calculate precise expected reimbursement values.

Claims & Remittance Automation

• EDI Frameworks: Thorough knowledge of electronic data interchange processing and technical layout configurations.
• Outbound Claims (837P): Expert capability in mapping and formatting professional billing charges into compliant ANSI X12 837P data streams.
• Inbound Remittance (835): Advanced configuration of Electronic Remittance Advice (ERA) parsing and automated posting logic.
• CARC/RARC Mapping: Specialized skill in mapping Claim Adjustment Reason Codes and Remittance Advice Remark Codes to drive automated billing actions.

 Revenue Protection & Denial Mitigation

• Variance Auditing: Advanced design of variance tolerance thresholds to identify discrepancies where Payer Allowed Amounts fall below Epic Expected Reimbursement.
• Epic Rules Engine (CER / PAF): Mastery in writing complex, context-specific CER and PAF criteria to identify contract violations and isolate root-cause denials.
• Workqueue (WQ) Engineering: Experience structuring specialized Contract Variance and Remittance Follow-Up Workqueues to segregate financial disputes from daily billing operational queues.
• Bulk Appeal Routing: Implementation of single-click automated Follow-Up Activities to package dispute letters and appeal documentation directly from the user workspace.

Testing, Analytics & Data Operations

• Remittance Simulation: Proven track record of executing mock 835 cycles in Sandbox/Test (TST) environments to validate newly built contract portfolios prior to Production (PRD) deployment.
• SQL & Chronicles Reporting: Ability to run targeted audits on Chronicles data, identifying systemic payer patterns regarding underpayments and claim rejections.

Excellent verbal and written English communication skills and the ability to interact professionally with a diverse group are required.

CTG does not accept unsolicited resumes from headhunters, recruitment agencies, or fee based recruitment services for this role.

To Apply:

To be considered, please apply directly to this requisition using the link provided. Kindly forward this to any other interested parties. Thank you!

The expected base salary for this position ranges from $120,000 to $130,000. Salary offers are based on a wide range of factors including relevant skills, training, experience, education, market factors, and where applicable, licensure or certifications obtained. In addition to salary, a competitive benefit package is also offered.