Application Analyst III, Epic Tapestry Claims

San Ramon, CA, United States

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At Hill Physicians Medical Group, we're shaping the healthcare of the future: actively managed care that prevents disease, supports those with chronic conditions and anticipates the needs of our members.

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Job Description:

Overview:

Application Analyst III

Under the leadership of the Applications Manager, the Application Analysts primary role is to have a complete working knowledge of assigned application, to include an understanding of the assigned department workflows for the associated system build/configure, upgrade and release process. The Application Analyst will act as the primary support contact for the application and coordinate issues that arise in their area of responsibility and must be very knowledgeable about the organization's policies, procedures, and business operations. They will perform workflow analysis, data collection and report issues associated with the software. The Application Analyst will serve as a liaison between team, end users, third parties and technical staff. They will work with end users by participating in training and troubleshooting issues and questions. Senior level technical professional. Completes complex work within a discipline or specialty area. Helps others understand the why and articulates the importance to others they work with. Owns processes and continually incorporates feedback to improve them. Proactively audits process to improve before an issue occurs. Caters to individual styles and abilities. Teaches new skills. Helps talk through situations with operational stakeholders. Makes recommendations for new functionality for issue avoidance or operation improvement. Pushes back when operations or IT is steering down the wrong path.

Specialization

As an Epic Tapestry Claims Application Analyst, you will be a vital contributor to our team responsible for the accurate and efficient processing of healthcare claims through the Epic Systems Tapestry application. The Application Claims Analyst utilizes Tapestry application to process healthcare claims accurately and efficiently, you will configure:

• Epic to automate claims processing. Running AP claim file loads, send claims for retro-adjudication

• AP Claims workqueues, claim codes, and secondary payment methods

• Tapestry and test retro-adjudication to automatically reprocesses claims affected by retroactive changes

• Accounts Payable for AP claims, capitation, electronic funds transfer, and bank reconciliation

• General Ledger accounts for claims and capitation. Support workflows to recoup or refund the correct amount.

This role collaborates with business units, health plans, clearinghouses, system vendors, and audit teams working with health plans on errors and reconciliation activities; providing implementation and support for new health plans and actively monitors plan performance reporting; and communicates frequently with Clearinghouse on troubleshooting file issues and edit failures.

Application Claims Analyst will provide expert-level technical support, troubleshoot application-related issues, and resolution of complex problems. Collaborate with operational users to implement system updates and enhancements. Recommend and participate in the implementation of workflow optimizations to enhance efficiency and data accuracy. Create and maintain user-friendly documentation, guides, and best practices for application usage.

Job Responsibilities:

Application Analyst III

Performs work that is complex and varied in nature

Solves complex problems by defining and discerning key aspects of the problem

Takes a new perspective on existing solutions. Recommends new procedures and processes to achieve results.

Understands the why behind the question.

Communicates build/configure, or workflow improvements that solves the broader need.

Acting as the primary support contact for the application's end-users

Provide software product function, design, and build/configure expertise needed for successful product implementation.

Identifying issues that arise in their application area as well as issues that affect other application teams, and working to resolve them

Guiding workflow design, build/configuring and testing the system, and analyzing other technical issues associated with software ensuring design and configuration meets patient care and business needs

Works with the IS. Team members, vendors and customers to ensure that the application systems are properly maintained and necessary changes are reliably tested, implemented, and documentation is current. Serving as a liaison between end users' workflow needs and implementation staff

Maintaining regular communication with software representatives, business community, and end users to ensure the system meets the organization's business needs in regards to the project deliverables and timeline

Developing an understanding of operational needs to set the direction for the organization's workflows by attending site visits and other integrated sessions

Expert in workflows identifies areas for system optimization and process improvement. Develops solutions and collaborates with the team and management to implement these solutions.

Works to ensure that user problems and configuration requests are appropriately addressed, and system upgrades are successfully executed with minimal disruption to operations

Develops and manages effective customer relationships with end-users and other team members to enhance the timeliness and effectiveness of technology solutions.

Responds promptly to the needs of end-users, and meets Service Level Agreements as defined in conjunction with our customers following issues through to closure.

Participates in team and leadership meetings to discuss team and ongoing project related activities, issues, change, communications, and updates.

Typically provides training and guidance to colleagues with less experience, but no formal supervisory responsibility

May be accountable for leading small projects with moderate risk

Recognizes when the team needs to be given direction. Proactively looks for feedback to share in their peers work and solicits feedback in return.

Proactively teaches others on the team. Seeks out areas or issues to lead.

Digs deeper to root out potential issues or opportunities.

Required Experience and Professional Skills

Application Analyst III

Experience 5-7 years of Epic Tapestry Claims build, configuration and workflow experience required

Professional Skills Complete application system knowledge

Strong interpersonal skills

Requires in-depth knowledge and experience. Has developed deep conceptual and practical expertise in own discipline and basic knowledge of related disciplines

Understands workflows, and makes thoughtful recommendations on the fly. Creates unique solutions based on experiences and knowledge of other's build/configure and workflows. Incorporates future software direction into recommendations. Expert in a given area.

Solves basic issues for integrated areas independently. Validates recommendations with other teams.

Brings perspective from other organizations and tailors message based on operational needs.

Ability to tailor communication to the audience. Communicates priority and urgency directly.

Demonstrated ability to collaborate effectively with others, gain trust and build/configure strong relationships

Ability to work independently and function as an integral part of the team

Flexibility and adaptability with respect to changing end-user business needs

The ability and willingness to see things in an open-minded way and examine an idea or concept from as many angles as possible

The ability and willingness to take ownership of work activities and ensure that they are completed in an accurate, efficient, and timely manner

The ability and willingness to recognize assignments or tasks that need to be completed, to seek out additional assignments or tasks, and to help others

The ability to gain trust and establish effective relationships with system end users, business unit and vendor counterparts

The ability and willingness to learn new software and systems

Seeking, logically examining, and interpreting information from different sources to determine a problem's cause and developing a course of action to resolve the problem and to prevent its recurrence bring effective solutions to complex customer problems

The ability to persevere in difficult situations, overcome obstacles, and reach high levels of performance when faced with stressful work situations and time pressures

The willingness to put forth extra effort when required, including demonstrating persistence in the face of obstacles and adversity

Strong analytical and problem solving skills. Excellent oral and written communication skills both technical and business focused.

The ability to communicate information clearly and concisely with leadership and subject matter experts

Required Education and Certifications

Application Analyst III

Education Master's Degree preferred, minimum Bachelor Degree in Computer Science, Information Systems, Business Administration, or Healthcare Administration or equivalent work experience

Certifications Epic Tapestry Claims Certification required, Certifications in other Epic Modules preferred

Salary:

$110,000.00 - $150,000.00 US Annual

Hill Physicians is an Equal Opportunity Employer