Remote Epic Resolute Professional Billing Application Analyst (Certified)

ResponsibilitiesCharge Adjustment Review

• Configure and maintain Professional Billing Adjustment Review Workqueues.
• Build routing and error rules supporting refund adjustment approval workflows.
• Configure dollar-based approval thresholds and approval-level validation logic.
• Develop cascading tiered approval workflows based on adjustment authority.
• Configure workqueue routing rules, authorized users, review criteria, and approval levels to improve workflow efficiency.

Retroactive Processing (Retro Experience)

• Support Epic Professional Billing retroadjudication workflows.
• Analyze insurance coverage changes affecting visit filing order and claim routing.
• Utilize Filing Order Adjustment Logic (FOAL) to validate coverage responsibility.
• Review and support charge reposting workflows following insurance updates.
• Troubleshoot billing impacts caused by retroactive coverage changes.

Claims & Statements

• Configure and maintain Claim Definition Files (CDFs).
• Validate claim edits, processing rules, and error handling workflows.
• Analyze remittance transactions utilizing:
• CARCs
• RARCs
• Group Codes
• Support denial management including:
• Denied Claims
• Research
• Write-Offs
• Transfer to Self-Pay
• Next Responsible Party (NRP)
• Configure and maintain follow-up workqueues for denied claims.
• Configure statement workflows including:
• Statement Cycles
• Statement Templates
• Billing Exclusions
• Payment Plan Proposals
• Patient Statement Settings

Single Billing Office (SBO)

• Support Epic Enterprise Self-Pay Platform and Single Billing Office workflows.
• Configure SBO statement templates.
• Maintain guarantor account settings.
• Configure statement cycles and patient communication workflows.
• Build and maintain SmartText statement templates.

Financial Assistance (MFA)

• Partner with operational and revenue cycle teams to improve billing workflows.
• Support automation initiatives using:
• System Actions
• Automatic Activities
• Participate in payer platform optimization.
• Configure billing settings, security classes, and system workflows.
• Assist with Accounts Receivable reduction initiatives and revenue cycle optimization.

Are you an Epic Certified Resolute Professional Billing (PB) expert with deep experience in Professional Billing configuration, revenue cycle optimization, and claims management? We are seeking a highly skilled Epic Resolute PB Application Analyst to join our team remotely and support complex Professional Billing initiatives focused on workflow optimization, automation, and reimbursement accuracy.

This role is ideal for an analyst with extensive experience in Charge Adjustment Review, Retroactive Processing, Claims & Statements, Self-Pay (SBO), and Financial Assistance (MFA) within Epic.

Required Certifications

• Current Epic Resolute Professional Billing (PB) Certification - REQUIRED
• Epic Hospital Billing (HB) Certification - Preferred
• Epic Claims & Remittance Administration Certification - Preferred, * Epic Resolute Professional Billing (PB) Certification (Current)
• 5+ years of Epic Professional Billing Application Analyst experience
• Strong Professional Billing build and configuration experience
• Experience with Charge Adjustment Review Workqueues
• Experience configuring approval routing workflows
• Experience with Retroactive Billing and Retroadjudication
• Strong understanding of Filing Order Adjustment Logic (FOAL)
• Experience configuring Claim Definition Files (CDFs)
• Experience supporting Claims and Remittance workflows
• Experience with CARCs, RARCs, Group Codes, and denial management
• Experience configuring statement cycles and patient statements
• Experience with Single Billing Office (SBO)
• Experience configuring SmartText templates
• Knowledge of Epic Financial Assistance workflows
• Excellent analytical, troubleshooting, and communication skills

Preferred

• Epic Hospital Billing Certification
• Epic Claims & Remittance Administration Certification
• Experience with Accounts Receivable optimization
• Experience supporting large healthcare systems
• Knowledge of revenue cycle reporting and analytics

Preferred Technical Experience

• Epic Professional Billing (PB)
• Epic Hospital Billing (HB)
• Claims & Remittance Administration
• Charge Router
• Workqueues
• Claim Definition Files (CDF)
• FOAL
• Retroadjudication
• SBO
• SmartText, * Are you Epic PB Certified?
• Do you have experience with Charge Adjustment Review?
• Do you have experience with Retro?
• Do you have experience with Claims and Statements?
• Do you have experience with SBO?
• Do you have experience with MFA?

• Revenue Cycle Optimization
• Accounts Receivable
• Denial Management
• Refund Processing
• Payment Plans
• Epic Reporting Workbench (preferred)

Why Join Us?

• 100% Remote
• Work with a highly collaborative Epic Revenue Cycle team
• Opportunity to support enterprise-level Epic initiatives
• Challenging projects focused on workflow automation and revenue optimization
• Competitive compensation
• Long-term project opportunities