[Hiring] EPIC PB Claims Analyst @ZipStaff

Role Description

ZipStaff is hiring an EPIC PB Claims Analyst (Claims Certification) for our client, a leading healthcare organization. This 6-month contract is a 100% remote role focused on designing, building, and optimizing Professional Billing (PB) claims processing logic and workflow engines in Epic Resolute PB and Claims. You will focus on claim statusing (276/277 workflows, clearinghouse integration, and workqueues) so claims move through adjudication to clean submission and rapid reimbursement. An active vendor Claims Certification (such as Epic Claims Certification) and deep hands-on claims build expertise are required.

• Build and configure automated claim statusing workflows using ANSI ASC X12 EDI transactions (276/277), including clearinghouse integration, 999/277CA acknowledgment ingestion, and payer statusing bridges.
• Construct and refine Account and Claim Status Workqueues with automated routing, and analyze lag times and payer response trends to reduce Days in A/R.
• Configure and maintain the Claims build, Claim Definition files (CDF), payer output formats (CMS-1500 / 837P), claim edit rules, and validation criteria to drive first-pass clean claim rates.
• Manage payer ID mapping, provider credentialing mapping and overrides, taxonomy crosswalks, and Revenue Module Object (RMO) billing rules.
• Conduct unit, integrated, and end-to-end testing for new claims build, system upgrades, and annual regulatory and payer updates.
• Partner with billing and Revenue Integrity teams on root-cause analysis of pre-bill edits, clearinghouse rejections, and post-submission denials, and troubleshoot claims interface and EDI engine issues.

Qualifications

• Active vendor Claims Certification is required (for example, Epic Claims Certification / Resolute Claims Administration).
• 3-5+ years of hands-on technical build and configuration experience in healthcare revenue cycle applications, with direct ownership of PB claims engine workflows.
• Proven expertise in Claim Definitions (CDF), Claim Logic Rules, 837P EDI formatting, and claim edit workqueue configuration.
• Extensive experience with EDI standards, specifically 276/277 claim statusing, 837P claim generation, and 835 payment remittance integration.
• Bachelor's degree in Healthcare Information Systems, Computer Science, Business Administration, or equivalent relevant experience.

Preferred Qualifications

• Additional or dual certification in Epic Resolute Professional Billing (PB) Administration or Epic Charge Router.
• Experience with healthcare clearinghouses (for example, Change Healthcare, Experian Health, Waystar, or Availity).
• Background in Single Billing Office (SBO) workflows and integration with Hospital Billing (HB) and Cadence scheduling.
• Proficiency with SQL, Epic Reporting Workbench, or Radar Dashboards to monitor claims throughput and workqueue health.

Benefits

• Health Insurance
• Dental Insurance
• Vision Insurance
• 401(k) + matching
• Paid time off
• Referral Program