RCM Enrollment Analyst

SUMMARY:

The RCM Enrollment Analyst - Epic Workqueues & EDI is responsible for executing and monitoring provider and payer enrollment activities that support clean claim submission, accurate reimbursement, and regulatory compliance within an Epic Revenue Cycle environment.

This role focuses on day-to-day management of Epic workqueues (WQs) tied to enrollment, payer setup, and EDI connectivity, partnering with Revenue Cycle, Credentialing, IT/Epic teams, and external payers/clearinghouses to resolve issues impacting electronic claims, remittances, and eligibility transactions.

Brown University Health employees are expected to successfully role model the organization's values of Compassion, Accountability, Respect, and Excellence as these values guide our everyday actions with patients, customers and one another.

In addition to our values, all employees are expected to demonstrate the core Success Factors which tell us how we work together and how we get things done. The core Success Factors include:

Instill Trust and Value Differences
Patient and Community Focus and Collaborate

RESPONSIBILITIES:

• Monitor, triage, and resolve Epic Workqueues (WQs) related to provider enrollment, payer enrollment, and EDI/clearinghouse connectivity to prevent billing delays and claim rejections.
• Analyze WQ trends and root causes (e.g., missing/expired enrollment, incorrect effective dates, provider/payer mismatches) and implement corrective actions and escalation pathways.
• Maintain accurate provider enrollment-related data in Epic (e.g., NPI, taxonomy, billing provider relationships, group affiliations, service locations, and effective/term dates) in alignment with payer and operational requirements.
• Coordinate enrollment and revalidation activities with Medicare, Medicaid, and commercial payers; complete and track submissions through CAQH, PECOS, payer portals, and state systems as applicable.
• Manage payer EDI enrollment for applicable transactions (including 837 claims, 835 ERA, 270/271 eligibility, and 276/277 claim status; 278 authorizations as applicable), ensuring timely onboarding and production readiness.
• Partner with clearinghouse and payer representatives to submit, validate, and troubleshoot EDI enrollments, acknowledgements, and rejections; document findings and resolution steps.
• Collaborate with Revenue Cycle operations, Credentialing, Contracting, and IT/Epic teams to ensure enrollment approvals and payer connectivity are accurately reflected in Epic build and downstream billing workflows.
• Develop and maintain tracking tools and reporting for enrollment status, WQ aging, turnaround times, and recurring issues; communicate progress, risks, and recommendations to leadership.

MINIMUM QUALIFICATIONS:

BASIC KNOWLEDGE:

• Associate's or Bachelor's degree in Healthcare Administration, Health Information Systems, Business, or related field; or equivalent combination of education and experience.
• Minimum 2 years of experience in provider enrollment, payer enrollment, credentialing support, or revenue cycle operations, with demonstrated workqueue-based issue resolution.
• Demonstrated proficiency working within an Epic Revenue Cycle environment and navigating Epic workqueues and enrollment-related workflows.
• Working knowledge of EDI transaction types and payer onboarding requirements (837, 835, 270/271, 276/277; 278 as applicable).
• Strong understanding of payer rules, enrollment requirements, and regulatory compliance (including HIPAA and CMS guidance as applicable).
• Excellent organizational, analytical, communication, and customer service skills with the ability to manage multiple priorities and deadlines.

Preferred Qualifications:

• Epic proficiency and/or certification in revenue cycle modules (e.g., Prelude, Resolute, Cadence) preferred.
• Experience working with clearinghouses and payer portals (e.g., Availity, Waystar, Change Healthcare/Optum, state Medicaid portals) preferred.
• Revenue cycle or project/process improvement credentials (e.g., HFMA CRCR, Lean Six Sigma, PMP) a plus.

Working Conditions:

• Hybrid or potential for fully remote work arrangements (based on business need and organizational policy).
• May require occasional travel to other facilities or meetings as needed.

Pay Range:

EEO Statement:

Brown University Health is committed to providing equal employment opportunities and maintaining a work environment free from all forms of unlawful discrimination and harassment.

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