Porter (helloporter.com)

Billing & Claims Analyst

Pompano Beach, FL

Sponsorship not specified$58k-$75kDetected 20 days ago

SQLExcelEHR/EMRCommunicationClaims Management

About the role

Our organization operates in a payer-contracted services model - delegated services, in-home assessments, HEDIS gap closure, and risk adjustment visits - billed through Athena in a mix of penny-claim/encounter-reporting and full-cost claim arrangements.
Because Athena's default logic is built for traditional fee-for-service billing, our claims regularly get flagged, held, or underpaid in ways that don't reflect actual problems.

Build and maintain recurring reports in Athena covering claim submission status, hold/edit queues, and payment status.
Maintain claim-aging reports so nothing sits in a hold queue unnoticed.
Perform basic first-line correction on claims where the fix is known and documented, escalating anything new or ambiguous.
Support for Systemic Fixes
Document recurring issues (e.g., a specific hold code affecting a specific payer or claim type) with enough detail for the Operations Lead to escalate to Athena or the payer.
Support testing and validation whenever a new custom rule or workflow change is implemented in Athena, confirming it behaves as expected across a sample of claims.
tracking what's been submitted, what's stuck, what's been paid, and what's been invoiced separately - and flagging patterns to the Revenue Cycle & Claims Operations Lead so they can be fixed at the source.
We deliver understanding, compassion, information, and peace of mind for your members.

Working proficiency in Athena (or comparable EMR/RCM system) - running reports, navigating claim status and hold queues, and pulling claim-level detail.

Prior exposure to value-based care, risk adjustment, HEDIS, or delegated/capitated billing models.
Experience with encounter data reporting or non-standard (non-FFS) claim types.
Familiarity with payer portals for claim status verification.
A supportive, collaborative work environment.
SQL or other data-query experience is a plus but not required.

Competitive wage and benefits package.
Opportunities for professional growth and continuing education.
Porter is a leading healthcare IT and services platform for care and coverage coordination that optimizes outcomes and member experience.

This listing is sourced directly from Porter (helloporter.com)'s careers page and normalized into a canonical job model.