Porter (helloporter.com)

Revenue Cycle & Claims Operations Lead

Pompano Beach, FL

Sponsorship not specified$115k-$150kDetected 20 days ago

EHR/EMRMentoring

About the role

Our organization operates in a payer-contracted services model - including delegated services, in-home assessments, HEDIS gap closure, and risk adjustment visits - rather than traditional fee-for-service care.
Our billing patterns vary by payer and may include "penny claims" for encounter reporting paired with separate plan invoicing, or full-cost claims billed at the full contracted (allowable) rate.
Our EMR/RCM platform, Athena, is built around traditional fee-for-service economics: maximizing collections, flagging low-dollar claims as errors, and defaulting to standard allowable-amount and co-insurance logic.

Responsibilities

Partner directly with Athena's professional services / support team to build and maintain custom rules that suppress inappropriate low-dollar ("penny claim") edits and prevent unwanted allowable-amount or co-insurance recalculation on contracts where the full billed amount is the contracted rate.
Maintain a living documentation set of every custom rule, workaround, and configuration decision made in Athena, including rationale and payer applicability.
Design and maintain recurring reports covering: claim submission status, current holds and aging, partial payment / underpayment tracking, and payer-specific exception trends.
Direct and review the work of the Billing & Claims Analyst in building and running these reports.
Surface patterns (e.g., a hold type recurring across many claims for one payer) and use them to drive systemic fixes rather than one-off corrections.
Lead a structured 90-day assessment of Athena's fit for our billing model (see companion scoping document) and deliver a clear recommendation: continue to mitigate within Athena, or scope a transition to an alternative platform.
If migration is recommended, lead requirements-gathering and RFP scoping for a replacement EMR/RCM system suited to delegated/value-based billing models.
We deliver understanding, compassion, information, and peace of mind for your members.
to understand our payer contracts and billing models deeply, to configure and manage Athena as effectively as the platform allows, to build the reporting infrastructure needed to see what's actually happening to our claims, and to make a clear, well-supported recommendation on whether our long-term path is continued mitigation within Athena or migration to a different platform.

Requirements

Direct, hands-on experience with value-based care, risk adjustment, HEDIS/quality gap closure, delegated services, or other non-fee-for-service payer arrangements -
Ability to read and interpret payer contract language and translate contractual terms into system requirements.
Demonstrated ability to work cross-functionally with finance, operations, and external vendor teams, and to advocate persistently when a vendor's default assumptions don't fit the business model.

Nice to have

Prior experience evaluating or migrating between EMR/RCM platforms.
Familiarity with encounter data reporting standards and delegated/capitated payer relationships.
Certification such as CRCR (Certified Revenue Cycle Representative) or equivalent.
Experience managing or mentoring junior billing/claims staff.
A supportive, collaborative work environment.

Compensation

Competitive wage and benefits package.
A supportive, collaborative work environment.

Benefits

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.

Company info

maximizing collections, flagging low-dollar claims as errors, and defaulting to standard allowable-amount and co-insurance logic.
This creates a persistent structural mismatch with our billing model.
We are hiring a

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