Epic Tapestry Analyst

This role partners with payer operations, claims, enrollment, revenue cycle, contracting, and IT teams to ensure efficient management of health plan operations, benefits, eligibility, authorizations, claims adjudication, and reimbursement workflows. The Epic Tapestry Analyst is responsible for the design, configuration, implementation, optimization, testing, and ongoing support of the Epic Tapestry (Managed Care/Payer) application.

The Epic Tapestry Analyst is responsible for the design, configuration, implementation, optimization, testing, and ongoing support of the Epic Tapestry (Managed Care/Payer) application. This role partners with payer operations, claims, enrollment, revenue cycle, contracting, and IT teams to ensure efficient management of health plan operations, benefits, eligibility, authorizations, claims adjudication, and reimbursement workflows. 


Key Responsibilities

•  Configure, build, maintain, and optimize Epic Tapestry application components. 
•  Support benefit plans, products, packages, coverage rules, eligibility, and enrollment workflows. 
•  Configure claims adjudication logic, reimbursement methodologies, fee schedules, and payment policies. 
•  Build and maintain authorizations, referrals, and utilization management workflows. 
•  Support payer contracts, coordination of benefits (COB), and provider reimbursement processes. 
•  Gather and analyze business requirements and translate them into Epic system solutions. 
•  Perform system configuration, testing, validation, and deployment activities. 
•  Execute unit testing, integrated testing, and User Acceptance Testing (UAT). 
•  Troubleshoot application issues and provide production support. 
•  Collaborate with Revenue Cycle, Claims, Enrollment, Contracting, Finance, and Provider Relations teams. 
•  Support interfaces and integrations with Epic applications and external payer systems. 
•  Develop and maintain system documentation, workflows, build specifications, and training materials. 
•  Participate in implementation, optimization, upgrade, and go-live activities. 
•  Ensure compliance with HIPAA, CMS, Medicare, Medicaid, and healthcare payer regulations. 

Required Qualifications

•  Epic Tapestry Certification required (Claims, Membership, Enrollment & Eligibility, CRM, Utilization Management, or related Tapestry certification preferred). 
•  3+ years of Epic Tapestry build and support experience. 
•  Strong understanding of payer operations, managed care, claims processing, and health plan workflows. 
•  Experience with benefits configuration, eligibility, enrollment, authorizations, and claims adjudication. 
•  Knowledge of healthcare regulations and payer requirements. 
•  Excellent analytical, troubleshooting, and problem-solving skills. 
•  Strong communication and stakeholder management abilities. 
•  Experience supporting Epic implementations, upgrades, and optimization projects. 

Preferred Qualifications

•  Experience with Medicare, Medicaid, and Commercial Health Plans. 
•  Knowledge of EDI, ANSI transactions, HL7 integrations, and payer interfaces. 
•  Experience with Epic Clarity, Caboodle, Reporting Workbench, or SQL reporting. 
•  Familiarity with Revenue Cycle, Claims, Enrollment, and Contracting operations. 
•  Prior consulting or multi-site healthcare implementation experience. 

Technical Skills

•  Epic Tapestry Configuration & Build 
•  Claims Adjudication 
•  Enrollment & Eligibility 
•  Benefits Administration 
•  Utilization Management (UM) 
•  Referrals & Authorizations 
•  Provider Contracting 
•  EDI / ANSI Transactions 
•  Reporting & Analytics 
•  Workflow Analysis & Optimization 
•  Testing & Validation 
•  Production Support 

Preferred Certifications

•  Epic Tapestry Certification 
•  Epic Tapestry Claims Administration 
•  Epic Tapestry Membership 
•  Epic Tapestry Enrollment & Eligibility 
•  Epic Tapestry Utilization Managemen