Benefit Analyst - Epic Tapestry Configuration Job at Hill Physicians Medical Group, San Ramon, CA

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  • Hill Physicians Medical Group
  • San Ramon, CA

Job Description

Job Description

We are seeking a Benefit Analyst with strong technical expertise to join our Business Operations team . This role focuses on translating complex Evidence of Coverage (EOC) documents into precise Epic Tapestry benefit configurations , ensuring accurate member cost shares, accumulators, and benefit limits. The analyst will collaborate closely with IT Application Analysts to implement new benefits, configuration changes, and system corrections with a high degree of accuracy and compliance.

Key Technical Responsibilities

  • Interpret and analyze EOCs across multiple health plans and convert requirements into Epic Tapestry configuration .
  • Configure and map benefit plans for diverse products (HMO, POS, Medi-Cal, Medicare, Exchange).
  • Align CPT, HCPCS, REV, ICD-10 codes to benefit categories and validate coding logic.
  • Analyze authorization rules and Division of Financial Responsibility (DOFR) for accurate system setup.
  • Perform QA and validation of benefit configurations, including accumulators and cost-share logic.
  • Execute system testing for new benefits and complex configuration changes within claims processing workflows.
  • Investigate and resolve pending claims caused by configuration issues; adjudicate claims and apply corrective adjustments.
  • Collaborate with IT to troubleshoot configuration errors, submit fixes, and document outcomes.
  • Maintain benefit configuration standards, policies, and procedures; recommend process improvements for scalability.
  • Conduct workflow analysis and consult on process optimization for new functionality and system upgrades.
  • Partner with IT, Enrollment, Claims, and Contracting teams to ensure benefit accuracy and regulatory compliance.

Technical Requirements

  • 5+ years in benefit configuration and claims within Managed Care or delegated model.
  • Hands-on experience with Epic Tapestry (preferred).
  • Strong knowledge of medical coding (CPT, HCPCS, REV, ICD-10) and claims adjudication logic.
  • Familiarity with CMS mandates, NCDs, LCDs , and regulatory requirements for multiple plan types.
  • Proficiency in Excel (VLOOKUP, Pivot Tables) and Microsoft 365 ; experience with data validation and QA testing .
  • Certified Medical Coder (preferred) or equivalent coding expertise.
  • Strong analytical and documentation skills; ability to work independently in a fast-paced environment.

Preferred Skills

  • Experience with benefit mapping , system integration , and claims workflow optimization .
  • Knowledge of cost-share accumulators , out-of-pocket maximums, and benefit limit logic.
  • Familiarity with testing frameworks and QA methodologies for healthcare systems

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