PB Denial Specialist - EPIC

• Identify, analyze, and trend common denial reasons (e.g., medical necessity, lack of authorization, coding errors, timely filing, incorrect modifiers).

• Develop and implement strategies to overturn denials and accelerate payment resolution.

• Act as a subject matter expert for Epic Resolute PB, specifically as it relates to denial prevention and resolution.

• Analyze Epic workflows and configurations to identify root causes of denials stemming from system setup or user error.

• Assist in troubleshooting Epic PB-related issues that lead to denials.

• Develop and maintain denial management policies and procedures.

• Prepare and present regular reports on denial trends, recovery rates, and team performance to RCM leadership and clients.

We are seeking a highly motivated and experienced Denial Specialist with a strong background as an Epic Professional Billing (PB) Analyst. In this crucial role, you will lead a team of denial specialists, driving the resolution of denied claims, identifying root causes, and implementing strategies to prevent future denials. Your dual expertise in denial management and Epic PB functionality will be critical in optimizing workflows, providing actionable insights, and ensuring maximum revenue capture for our clients. This is a W-2 employee position with an expected term of six months, there is a potential for extension or permanent employment based on business and project needs., * 1+ years of direct, hands-on experience as an Epic Professional Billing (PB) Analyst or in a role heavily utilizing Epic PB for operational analysis and workflow optimization.

• Epic Resolute PB Certification is highly preferred. Additional Epic certifications (e.g., Prelude, Cadence) are a plus.

• Strong understanding of professional medical coding (CPT, ICD-10, HCPCS), claim submission (CMS-1500), and remittance processing (ERA/EOB).

• Exceptional analytical, problem-solving, and critical thinking skills.

• Excellent leadership, communication (verbal and written), and interpersonal skills.

• Proficient in Microsoft Excel (for data analysis and reporting).