Epic Application Analyst l, II, lll, Tapestry; Core Administration, Utilization Management

Epic Application Analyst l, II, lll, Tapestry (Core Administration, Utilization Management or Benefits)

Epic Application Analyst (I, II or III), Tapestry Core Administration, Utilization Management or Benefits roles will be based on experience and qualifications. Must have Epic Certification in Tapestry Core, Utilization Management or Benefits. This position is on-site in Southern California.

Tapestry Core:

• Understanding of operations within the AP Claims department, including claim intake, review, and payment
• Familiarity with integration points with other areas of business, such as eligibility, authorizations, and internal claims
• Familiarity with the benefit structure of plans that your organization administers.
• Familiarity with your organization's managed care vendor contracts
• Familiarity with operations and workflows in a Management Services Organization
• Ability to collaborate with cross-functional teams, including Claims, Utilization Management, Provider Network Operation, Case Management, Eligibility and Capitation management.
• Strong analytical, technical, and troubleshooting skills
• Demonstrating flexibility with respect to changing end ‐ user business needs
• 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 communicate information clearly and concisely with project leadership and subject matter experts
• The ability to gain trust and establish effective relationships with Epic counterparts
• The ability and willingness to learn new software and systems
• Listening attentively to ensure that the intended message has been accurately received, holding responses until the person have finished making their point, and repeating information to ensure accuracy
• 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
• The ability to persevere in difficult situations, overcome obstacles, and reach high levels of performance when faced with stressful work situations and time pressures

Tapestry Membership:

• Familiarity with your managed care organization benefit structures regarding carriers, plans, and employer groups
• Understanding of ANSI or proprietary files received
• Ability to managing enrollment file loads from payers
• Familiarity with operations and workflows in a Management Services Organization
• Ability to collaborate with cross-functional teams, including Claims, Utilization Management, Provider Network Operation, Case Management, Eligibility and Capitation management.
• Strong analytical, technical, and troubleshooting skills
• Demonstrating flexibility with respect to changing end‐user business needs
• 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 communicate information clearly and concisely with project leadership and subject matter experts
• The ability to gain trust and establish effective relationships with Epic counterparts
• The ability and willingness to learn new software and systems
• Listening attentively to ensure that the intended message has been accurately received, holding responses until the person have finished making their point, and repeating information to ensure accuracy
• 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
• The ability to persevere in difficult situations, overcome obstacles, and reach high levels of performance when faced with stressful work situations and time pressures

Tapestry Utilization Management:

• Familiarity with prior authorization requirements, utilization management content, and network structure
• Understanding of authorization policies and procedures that affect the automatic approval or denial of authorizations
• Knowledge of areas that integrate with UM or referrals, including scheduling referrals, creating authorizations from orders, and using authorizations to pay claims…