EPIC Tapestry Systems Quality Analyst - Remote

Summary

UnitedHealth Group, through Optum Insight, works to improve the flow of health data and create a more connected healthcare system. The Epic Information Systems Quality Analyst translates payer and provider requirements into Epic configurations and business rules, validates application builds, and supports risk operations across claims, eligibility, benefits, contracts, provider setup, and payments. The role also manages quality assurance, documentation, issue resolution, compliance, and implementation activities.

Responsibilities

• Review payer and provider contracts, reimbursement terms, and healthcare business requirements; break complex content into detailed system and operational requirements
• Configure and maintain Epic application builds and business rules supporting claims, eligibility, benefits, contracts, provider setup, payments, and related payer operations
• Perform quality assurance reviews of application builds to verify that configuration is accurate and transactions are processing as intended
• Identify build or processing issues, coordinate corrective action and retroactive claims reprocessing when needed, and support process improvements that reduce recurrence
• Support new features, upgrades, new health plans, new payers, benefit plans, and member implementations from requirements through go-live readiness
• Develop and maintain build documentation, test evidence, quality audit materials, process documentation, and implementation records
• Partner with business operations, IT, project teams, health plans, vendors, clients, and other internal stakeholders to support successful delivery
• Help ensure solutions align with applicable regulatory, health plan, client, and operational requirements
• Use Microsoft Excel for reporting, tracking, contract analysis, validation, and organization of detailed requirements

Skills

• * Current or Epic certification in at least one Epic application or module. The certification may be active or inactive and does not need to be in Epic Tapestry
• * 3+ years of experience supporting Epic applications through configuration, build, systems analysis, testing, quality assurance, issue resolution, implementation, upgrades, or production support
• * 3+ years of experience in healthcare payer operations, managed care, health plan operations, claims, eligibility, benefits, contract administration, provider reimbursement, or a closely related healthcare business environment
• * Experience interpreting complex healthcare business requirements, payer contracts, provider contracts, reimbursement terms, or business rules and translating them into system configuration, workflows, or technical requirements
• * Experience reviewing, validating, testing, auditing, or quality-checking system configuration, application builds, business rules, or operational processes
• * Intermediate to advanced Microsoft Excel skills for analysis, reporting, tracking, reconciliation, or requirements validation
• * Demonstrated ability and willingness to obtain or reactivate role-specific Epic certifications after hire, based on business needs and training availability. The hiring team anticipates completion within approximately one year
• * Demonstrated solid analytical skills and attention to detail, including the ability to break complex information into logical components and evaluate whether system outcomes align with requirements
• * Ability to travel up to 10%, primarily as needed for Epic training or certification
• * Epic Tapestry experience or certification
• * Epic certification or hands-on experience in Contracts, Eligibility, Benefits, Claims, or related payer workflows
• * Experience with healthcare payer configuration, claims adjudication, contract implementation, provider reimbursement, or payment operations
• * Experience performing root cause analysis and resolving complex application or operational issues
• * Experience supporting system upgrades, new functionality, implementations, testing cycles, or go-live activities
• * Experience coordinating retroactive claims correction or reprocessing
• * Experience creating build documentation, quality audit records, test scenarios, or implementation documentation
• * SQL experience or experience using comparable data-analysis and reporting tools
• * Demonstrated ability to communicate effectively with technical and nontechnical stakeholders and to explain detailed business and system information clearly

Qualifications

Must Haves

• * Current or Epic certification in at least one Epic application or module. The certification may be active or inactive and does not need to be in Epic Tapestry
• * 3+ years of experience supporting Epic applications through configuration, build, systems analysis, testing, quality assurance, issue resolution, implementation, upgrades, or production support
• * 3+ years of experience in healthcare payer operations, managed care, health plan operations, claims, eligibility, benefits, contract administration, provider reimbursement, or a closely related healthcare business environment
• * Experience interpreting complex healthcare business requirements, payer contracts, provider contracts, reimbursement terms, or business rules and translating them into system configuration, workflows, or technical requirements
• * Experience reviewing, validating, testing, auditing, or quality-checking system configuration, application builds, business rules, or operational processes
• * Intermediate to advanced Microsoft Excel skills for analysis, reporting, tracking, reconciliation, or requirements validation
• * Demonstrated ability and willingness to obtain or reactivate role-specific Epic certifications after hire, based on business needs and training availability. The hiring team anticipates completion within approximately one year
• * Demonstrated solid analytical skills and attention to detail, including the ability to break complex information into logical components and evaluate whether system outcomes align with requirements
• * Ability to travel up to 10%, primarily as needed for Epic training or certification

Nice to Haves

• * Epic Tapestry experience or certification
• * Epic certification or hands-on experience in Contracts, Eligibility, Benefits, Claims, or related payer workflows
• * Experience with healthcare payer configuration, claims adjudication, contract implementation, provider reimbursement, or payment operations
• * Experience performing root cause analysis and resolving complex application or operational issues
• * Experience supporting system upgrades, new functionality, implementations, testing cycles, or go-live activities
• * Experience coordinating retroactive claims correction or reprocessing
• * Experience creating build documentation, quality audit records, test scenarios, or implementation documentation
• * SQL experience or experience using comparable data-analysis and reporting tools
• * Demonstrated ability to communicate effectively with technical and nontechnical stakeholders and to explain detailed business and system information clearly

Benefits

• Remote work from anywhere within the U.S., subject to UnitedHealth Group's Telecommuter Policy
• A comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution