Epic Claims Configuration Architect

Avera Health Plans Inc; Sioux Falls (SD); On-site; USD 64,000 - 96,000; Full time

Job summary

Avera Health Plans in Sioux Falls, SD seeks a Configuration & Coding Analyst to design, configure, and support health plan claims administration systems for accurate adjudication.

You will translate benefit plans, provider contracts, and coding policies into system configuration, perform testing, and ensure CMS/HIPAA compliance while collaborating with Operations, IT, Compliance, and Provider Network teams.

Qualifications

• Certified coding credentials required or upon hire.
• Epic Chronicles familiarity and Epic Tapestry experience preferred.

Responsibilities

• Design, configure, implement, test, and maintain health plan claims administration systems.
• Interpret and translate EOCs, SBCs, contracts, and policies into compliant system configuration.
• Perform end-to-end testing and quality assurance of configuration changes.

Skills

Coding knowledge

Provider reimbursement concepts

Regulatory compliance

Analytical thinking

Cross-functional collaboration

Education

CCA - AHIMA

CPC - AAPC

CCS - AHIMA

Epic Tapestry Certification

Bachelor's in Healthcare Administration or Information Systems

Tools

Epic Chronicles

Microsoft Office Suite

Job description

Avera Health Plans in Sioux Falls, SD seeks a Configuration & Coding Analyst to design, configure, and support health plan claims administration systems for accurate adjudication.

You will translate benefit plans, provider contracts, and coding policies into system configuration, perform testing, and ensure CMS/HIPAA compliance while collaborating with Operations, IT, Compliance, and Provider Network teams.