Lead Consultant Analyst (Epic Tapestry/QNXT)

Visa:                      USC

Job Title:             Lead Consultant Analyst (Epic Tapestry/QNXT)

Location:             Remote- Must work PST time zone

Duration:             initial 3 months

Interview:           1 round of MS Teams

Candidates must have excellent people skills and strong verbal communication abilities.

Role:

Experienced Healthcare Payer Systems Consultant to conduct a comprehensive functional assessment of Epic Tapestry (Claims Management (CM), UM - Utilization Management, Data/Member Management (DM), and QNXT Claims Management functionality.

Key Responsibilities

• Assessment & Evaluation: Conduct in-depth analysis of existing workflows and functionality within both Epic Tapestry (CM, UM, DM) and QNXT (CM).
• System Integration Analysis: Evaluate the interoperability and data flow between Tapestry and QNXT to ensure accuracy, timeliness, and completeness of care management information.
• Documentation: Document existing workflows, identify gaps in functionality, and produce a detailed assessment report with actionable, prioritized recommendations for improvement.

Required Qualifications

• Minimum of 2 – 3 years of experience in configuring and maintaining QNXT (Utilization Management - UM module).
• Proven experience with Epic Tapestry (UM, CM, DM application).
• Strong SQL knowledge for ad-hoc reporting, data validation, and analysis.
• Understanding of commercial and government (Medicare Ad/Medi-Cal) benefit structures, claims adjudication, and care management configuration.
• Excellent verbal and written communication skills with the ability to present findings to executive management.