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Position Summary
We are seeking an
Epic RTE (Real-Time Eligibility) Certified Analyst/Consultant
to support, monitor, maintain, and enhance Epic RTE functionality across the organization. This individual will serve as a key resource for optimizing eligibility workflows, resolving operational issues, implementing new functionality, and supporting strategic initiatives related to insurance verification, benefits, coverage discovery, filing order automation, and denial prevention.
The consultant will initially focus on prioritizing and resolving existing tickets and enhancement requests, improving plan mapping processes, and ensuring the stability and effectiveness of RTE operations. The role will also provide mentoring and knowledge transfer to a junior RTE analyst, helping expand internal expertise and long-term support capabilities.
Key Responsibilities
Operational Support & Maintenance
Monitor and support Epic RTE production environments and related interfaces.
Prioritize and resolve ServiceNow tickets, operational requests, incidents, and enhancement requests.
Manage and troubleshoot payer availability issues, payer outages, and response time concerns.
Investigate and resolve high-priority unplanned eligibility issues.
Open and manage Experian support cases when appropriate.
RTE Configuration & Build
Maintain and enhance:
Plan Mapping configurations
Query Chaining logic and payer routing tables
Coverage Auto-Creation rules
RTE Alerts and Highlights
Facility and Visit Filing Order configurations
Benefits Engine configurations
Visit Type Benefit Grouper (VTBG) settings
Design, test, and implement new RTE functionality to support operational and regulatory requirements.
Eligibility & Coverage Discovery
Monitor and support:
Experian Coverage Discovery transactions
Eligibility response processing
Coverage auto-creation workflows
Medicare and Medicaid query processes
Quality control tables and related work queues
Analyze payer responses and improve automation to increase clean registration and coverage accuracy.
Reporting & Analytics
Develop, finalize, and maintain RTE operational and denial prevention reporting.
Configure batch reporting processes and automated file delivery.
Support reporting initiatives including:
MSPQ reporting
HAR reporting
Plan Map by Payer reporting
Professional Billing visit reporting
Copay collection reporting
Denial prevention reporting and root-cause analysis
Partner with operations teams to identify reporting opportunities that improve revenue cycle performance.
Revenue Cycle Optimization
Support benefits filing processes and benefits engine enhancements.
Analyze copay collection opportunities and payer-specific configurations.
Support denial prevention initiatives through data analysis and workflow improvements.
Implement enhancements to improve coverage accuracy, filing order logic, and reimbursement outcomes.
Stakeholder Collaboration
Meet regularly with Revenue Cycle, Patient Access, Operations, HB/PB, and Registration leadership.
Evaluate new business requests and provide guidance regarding Epic RTE capabilities and best practices.
Recommend scalable solutions aligned with Epic standards and organizational goals.
Partner with operational teams on Medicaid, Hospice, Home Health, Financial Assistance, and other strategic initiatives.
Mentorship & Knowledge Transfer
Provide hands-on mentoring and training to junior RTE team members.
Assist in growing internal expertise related to:
RTE build
Eligibility processing
Plan Mapping
Filing Order logic
Benefits Engine functionality
Reporting and troubleshooting
Create and maintain documentation, troubleshooting guides, and operational procedures.
Required Qualifications
Epic RTE (Real-Time Eligibility) Certification required.
5+ years of Epic Revenue Cycle experience with significant RTE build and support responsibilities.
Strong understanding of:
Eligibility Verification
Coverage Discovery
Plan Mapping
Filing Order Logic
Benefits Engine
Patient Access workflows
Revenue Cycle operations
Experience supporting production environments and troubleshooting payer connectivity issues.
Experience with reporting, data analysis, and operational performance improvement.
Experience working with cross-functional operational and technical teams.
Strong communication, problem-solving, and consulting skills.
Preferred Qualifications
Additional Epic certifications in HB, PB, Prelude, Cadence, or Referrals.
Experience with Experian Coverage Discovery.
Experience with Medicare and Medicaid eligibility processing.
Experience with denial prevention initiatives and revenue cycle optimization.
Previous mentoring or training experience.
Healthcare system or multi-hospital enterprise experience.
Key Areas of Responsibility
Payer Availability Monitoring
Experian Coverage Discovery
Query Chaining Maintenance
Plan Mapping Configuration
Coverage Auto-Creation
RTE Alerts & Highlights
Filing Order Configuration
MSPQ Support
Denial Prevention Reporting
Benefits Engine Support
Visit Type Benefit Grouper Management
Copay Automation & Analysis
Medicaid Program Support
Hospice & Home Health Eligibility Support
Work Queue Design and Optimization
Knowledge Transfer & Team Development