Job Description
Position Title: Certified Claims OR Certified Benefits consultant. (1 opening for each)
Location: Remote
Start Date: ASAP
End Date: At least on contract until August 2026 Go-Live, likely longer
Hours: 8-5 EST
Duties:
- Support build and configuration of claims, benefits, prior authorization, and referral workflows in Epic Tapestry.
- Assist in developing, executing, and documenting UAT scripts, ensuring business requirements are met and system functionality aligns with plan policies.
- Validate benefit setup, contract loads, fee schedules, PA rules, and claims adjudication logic.
- Collaborate with business analysts, project managers, IT, and operational SMEs to troubleshoot and resolve system issues during build and testing.
- Participate in issue tracking, root cause analysis, and resolution using tools like ServiceNow, ChangeGear, or similar.
- Provide guidance and expertise on Medicaid, Medicare, and Commercial health plan rules as they relate to claims and benefits processing.
- Contribute to process documentation, training materials, and knowledge transfer for the operational teams.
- Ensure regulatory compliance and adherence to project governance standards throughout build and UAT activities.
Job Tags
Contract work, Immediate start, Remote work,