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Job Summary

The Epic Payor Platform Applications Analyst/Health Data Management Exchange Analyst collaborates with internal business and technical teams, as well as external provider organizations, to support the implementation, configuration, and optimization of Epic Payer Platform applications. This role enables and maintains bidirectional exchange of clinical and administrative data between the health plan and provider partners, supporting workflows such as clinical data exchange, prior authorization, claims, and other Payer Platform capabilities.

Requirements

EDUCATION

Bachelor’s degree in Business, Healthcare, Nursing, Health Administration, Computer Science, or related field required.

EXPERIENCE & KNOWLEDGE

Minimum five (5) years experience in healthcare Information Technology (IT), health plan operations, or clinical data exchange required.

Experience with healthcare data standards and interoperability concepts (e.g., FHIR, HL7).

Experience analyzing data quality, mapping, and system performance to drive process improvements.

Experience supporting Epic applications, preferably Tapestry and/or Payer Platform functionality, preferred.

Knowledge of payer-provider workflows including prior authorization, claims, care management, and quality reporting (e.g., HEDIS).

ESSENTIAL ABILITIES

Demonstrated ability to work with external provider organizations and vendors to support integrations and data exchange.

Skills

• Analyze Information • Application Platforms • Cross-Functional Communications • Decision Making • Documentations • Evaluating Information • Inductive Reasoning • Integration Architecture • Interpersonal Communication • Organizing • Problem Solving • Process Information • Researching • Results Interpretation

Responsibilities

• Collaborates with internal stakeholders and vendors on system enhancements, upgrades, and new feature adoption. • Configures and supports Epic Payer Platform applications to enable payer-provider interoperability. • Develops and maintains documentation, workflows, and training materials for end users. • Ensures timely and accurate data exchange to support risk adjustment, care gap closure, quality measurement (e.g., HEDIS), and the development of member longitudinal health records. • Evaluates system performance, monitors data quality and mapping, and identifies opportunities to improve operational efficiency, reduce administrative burden, and enhance provider engagement. • Identifies and implements process improvements to enhance efficiency and reduce administrative burden. • Leverages reporting and analytics to monitor performance, identify trends, and support decision-making. • Monitors and ensures data quality, accuracy, and appropriate mapping across systems. • Partners with internal stakeholders, vendors, and provider teams to troubleshoot issues, support system enhancements, and drive adoption of Payer Platform capabilities that improve interoperability, streamline processes, and enable more effective, data-driven decision-making to improve member outcomes. • Partners with providers to onboard, test, and optimize Payer Platform integrations and workflows. • Troubleshoots application, integration, and workflow issues across payer and provider environments.

Certifications

Security Requirements

This position is identified as level three (3). This position must ensure the security and confidentiality of records and information to prevent substantial harm, embarrassment, inconvenience, or unfairness to any individual on whom information is maintained. The integrity of information must be maintained as outlined in the company Administrative Manual.

Segregation of Duties

Segregation of duties will be used to ensure that errors or irregularities are prevented or detected on a timely basis by employees in the normal course of business. This position must adhere to the segregation of duties guidelines in the Administrative Manual.

Employment Type

Regular

ADA Requirements

1.1 General Office Worker, Sedentary, Campus Travel - Someone who normally works in an office setting or remotely and routinely travels for work within walking distance of location of primary work assignment.