Epic Tapestry SME

EPIC TAPESTRY SME

The Epic Tapestry SME serves as the primary expert on Epic’s Tapestry module (Epic’s managed care / payer administration platform). Tapestry supports health plan and managed care operations, including member enrollment & eligibility, benefits configuration, claims adjudication, utilization management (UM)/authorizations, provider contracting/networks, premium billing, accounts payable, CRM, and related workflows.

The role focuses on configuration, optimization, implementation support, troubleshooting, and acting as the go-to advisor between business/operations stakeholders and IT/Epic teams. Positions are commonly found at health plans, provider-sponsored plans, pay-viders, large health systems with risk-bearing arrangements, and consulting firms.

Key Responsibilities

• Configure, build, maintain, and optimize Epic Tapestry applications (e.g., Claims, Membership/Enrollment & Eligibility, Benefits Engine, Utilization Management/Service Authorizations, Contracts, CRM, AP, Premium Billing).
• Analyze business/operational requirements and translate them into system design, workflows, and configuration decisions.
• Lead or support design workshops, impact analysis for change requests, and recommendation of standardized/best-practice builds.
• Perform unit, system, integrated, and user acceptance testing (UAT); create test scripts; triage and resolve defects.
• Support go-lives, upgrades, enhancements, cutover, and hyper-care (including on-call as needed).
• Troubleshoot complex issues related to claims adjudication, benefits, eligibility, authorizations, contracts, and integrations.
• Document builds, decision rationale, workflows, processes, and maintain traceability (requirements → configuration → testing).
• Collaborate with clinical, revenue cycle, enrollment, claims, provider contracting, compliance, and other Epic teams (e.g., Resolute, Bridges, Clarity/Cogito).
• Serve as mentor/SME to analysts, end users, and project teams; provide training and knowledge transfer.
• Ensure compliance with regulatory requirements (e.g., HIPAA, ANSI X12 transactions), organizational policies, and change control standards.
• Develop or support reports/analytics (Clarity, Reporting Workbench, Caboodle) and interfaces as needed.
• Participate in project governance, status reporting, risk/issue tracking, and continuous improvement initiatives.

Required Qualifications

• Current Epic Tapestry certification(s) in one or more areas (e.g., Claims, Membership/Enrollment & Eligibility, Utilization Management, Benefits Engine, Contracts Administration, CRM, Accounts Payable, Premium Billing). Multiple certifications preferred.
• 3+ years of hands-on Epic Tapestry experience (build, configuration, testing, support, and/or implementation), with stronger preference for 5+ years for senior/SME roles.
• Solid understanding of managed care / health plan operations (claims processing, benefits, eligibility, authorizations/UM, provider networks/contracts).
• Experience with full-cycle Epic implementations, optimizations, or upgrades.
• Strong analytical, problem-solving, and documentation skills.