Epic Billing Specialist

Position Summary

A well-known hospital system in California needs an Epic Billing specialist for a 3-6 month contract for a Go-Live project. 

Core Responsibilities

• Error Correction & Claim Clearing: Reviewing claims that have been flagged with errors (e.g., missing modifiers, incorrect patient demographics, or coding discrepancies) and updating the data to make the claim "clean". [1]
• Denial Management: Responding to insurance claim rejections by pulling clinical documentation, fixing billing codes, and resubmitting claims to ensure timely payment. [1]
• Charge Review and Auditing: Monitoring incoming medical charges from various clinical departments to ensure they are mapping correctly to the billing module before a claim is generated. [1, 2]
• Queue Maintenance: Managing the flow of the digital queues to prevent claims from aging or piling up, targeting a daily "work to zero" workflow. [1, 2]

Minimum Qualifications

• High school diploma or equivalent required; associate degree in healthcare administration, business, or related field preferred.
• Two (2) to four (4) years of medical billing, claims processing, or revenue cycle experience required.
• Minimum of one (1) year of hands-on experience working billing work queues in Epic Resolute (HB, PB, or both) required.
• Working knowledge of UB-04 and CMS-1500 claim forms, CPT, HCPCS, ICD-10, and revenue codes.
• Familiarity with commercial, Medicare, Medicaid, and managed care billing requirements.

Preferred Qualifications

• Epic Resolute Hospital Billing or Professional Billing certification, proficiency, or credentialed training.
• Experience with clearinghouse platforms (e.g., Availity, Waystar, Experian) and payer portals.
• Certified Revenue Cycle Representative (CRCR), Certified Professional Biller (CPB), or comparable certification.
• Experience supporting work queue build, routing rules, or workflow redesign initiatives.

Mission-minded California hospital system that is focused on advanced technology and optimal patient care