Billing and Claims Analyst
Job Description
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<div><strong style="font-size: 24px;">Porter is hiring a Billing & Claims Analyst to join our Team!</strong></div>
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<div><strong><a rel="noopener noreferrer" href="http://www.helloporter.com" class="postings-link">Porter </a></strong>combines the power of analytics with the power of care. Porter is a leading healthcare IT and services platform for care and coverage coordination that optimizes outcomes and member experience. We deliver understanding, compassion, information, and peace of mind for your members. Driven by robust AI analytics, Porter’s Care Guide team helps the member navigate the healthcare delivery system, secures the right support for each member’s specific needs, and directs Porter’s team of expert clinicians to perform comprehensive in-home assessments, complete with lab and diagnostic testing. By coordinating the complexities of each unique care journey, Porter helps close the gaps with the largest impact on quality measures, total cost of care, risk adjustment, and member experience. </div>
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<p style="margin: 16pt 0in 7pt; background: #352368; font-size: 10.5pt; font-family: Calibri, sans-serif; color: #262626;"><strong><span style="font-size: 12pt; color: white;">ABOUT THE ROLE</span></strong></p>
<p style="margin: 0in 0in 7pt; font-size: 10.5pt; font-family: Calibri, sans-serif; color: #262626;">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.</p>
<p style="margin: 0in 0in 7pt; font-size: 10.5pt; font-family: Calibri, sans-serif; color: #262626;">We're hiring a Billing & Claims Analyst to be the day-to-day set of eyes on our 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.</p>
<p style="margin: 16pt 0in 7pt; background: #352368; font-size: 10.5pt; font-family: Calibri, sans-serif; color: #262626;"><strong><span style="font-size: 12pt; color: white;">KEY RESPONSIBILITIES</span></strong></p>
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<p style="margin: 11pt 0in 5pt; padding: 0in; font-size: 10.5pt; font-family: Calibri, sans-serif; color: #262626; border: medium none currentcolor;"><strong><span style="font-size: 11pt; color: #8662a7;">Reporting & Reconciliation</span></strong></p>
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<li style="margin: 0in 0in 3pt 0px; font-size: 10.5pt; font-family: Calibri, sans-serif; color: #262626;">Build and maintain recurring reports in Athena covering claim submission status, hold/edit queues, and payment status.</li>
<li style="margin: 0in 0in 3pt 0px; font-size: 10.5pt; font-family: Calibri, sans-serif; color: #262626;">Reconcile claims sent to payers against invoices sent separately for encounter/penny-claim arrangements, confirming amounts match and nothing has fallen through the cracks.</li>
<li style="margin: 0in 0in 3pt 0px; font-size: 10.5pt; font-family: Calibri, sans-serif; color: #262626;">Track partial payments and underpayments, flagging cases where Athena has applied a standard allowable amount or co-insurance deduction that conflicts with the actual contracted rate.</li>
<li style="margin: 0in 0in 3pt 0px; font-size: 10.5pt; font-family: Calibri, sans-serif; color: #262626;">Maintain claim-aging reports so nothing sits in a hold queue unnoticed.</li>
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<p style="margin: 11pt 0in 5pt; padding: 0in; border-width: medium medium 1pt; border-style: none none solid; border-color: currentcolor currentcolor rgb(188, 180, 223); border-image: initial; font-size: 10.5pt; font-family: Calibri, sans-serif; color: #262626;"><strong><span style="font-size: 11pt; color: #8662a7;">Claims Monitoring & First-Line Troubleshooting</span></strong></p>
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<li style="margin: 0in 0in 3pt 0px; font-size: 10.5pt; font-family: Calibri, sans-serif; color: #262626;">Monitor daily/weekly claim submission activity to confirm claims are actually reaching payers, not just leaving Athena.</li>
<li style="margin: 0in 0in 3pt 0px; font-size: 10.5pt; font-family: Calibri, sans-serif; color: #262626;">Review current holds in Athena, distinguish routine/expected holds from ones tied to our known penny-claim or allowable-amount issues, and route the latter for escalation.</li>
<li style="margin: 0in 0in 3pt 0px; font-size: 10.5pt; font-family: Calibri, sans-serif; color: #262626;">Perform basic first-line correction on claims where the fix is known and documented, escalating anything new or ambiguous.</li>
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<p style="margin: 11pt 0in 5pt; padding: 0in; border-width: medium medium 1pt; border-style: none none solid; border-color: currentcolor currentcolor rgb(188, 180, 223); border-image: initial; font-size: 10.5pt; font-family: Calibri, sans-serif; color: #262626;"><strong><span style="font-size: 11pt; color: #8662a7;">Support for Systemic Fixes</span></strong></p>
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<li style="margin: 0in 0in 3pt 0px; font-size: 10.5pt; font-family: Calibri, sans-serif; color: #262626;">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.</li>
<li style="margin: 0in 0in 3pt 0px; font-size: 10.5pt; font-family: Calibri, sans-serif; color: #262626;">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.</li>
<li style="margin: 0in 0in 3pt 0px; font-size: 10.5pt; font-family: Calibri, sans-serif; color: #262626;">Contribute claim-level detail to the 90-day Athena assessment and any future EMR evaluation.</li>
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<p style="margin: 16pt 0in 7pt; background: #352368; font-size: 10.5pt; font-family: Calibri, sans-serif; color: #262626;"><strong><span style="font-size: 12pt; color: white;">REQUIRED QUALIFICATIONS</span></strong></p>
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<li style="margin: 0in 0in 3pt 0px; font-size: 10.5pt; font-family: Calibri, sans-serif; color: #262626;">1–3+ years of experience in medical billing, claims processing, or revenue cycle operations.</li>
<li style="margin: 0in 0in 3pt 0px; font-size: 10.5pt; font-family: Calibri, sans-serif; color: #262626;">Working proficiency in Athena (or comparable EMR/RCM system) — running reports, navigating claim status and hold queues, and pulling claim-level detail.</li>
<li style="margin: 0in 0in 3pt 0px; font-size: 10.5pt; font-family: Calibri, sans-serif; color: #262626;">Strong Excel skills (pivot tables, VLOOKUP/XLOOKUP, basic reconciliation building); SQL or other data-query experience is a plus but not required.</li>
<li style="margin: 0in 0in 3pt 0px; font-size: 10.5pt; font-family: Calibri, sans-serif; color: #262626;">High attention to detail and comfort with repetitive reconciliation work — this role lives in the data, not just the summary.</li>
<li style="margin: 0in 0in 3pt 0px; font-size: 10.5pt; font-family: Calibri, sans-serif; color: #262626;">Clear written communication for documenting issues and escalations.</li>
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<p style="margin: 16pt 0in 7pt; background: #352368; font-size: 10.5pt; font-family: Calibri, sans-serif; color: #262626;"><strong><span style="font-size: 12pt; color: white;">PREFERRED QUALIFICATIONS</span></strong></p>
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<li style="margin: 0in 0in 3pt 0px; font-size: 10.5pt; font-family: Calibri, sans-serif; color: #262626;">Prior exposure to value-based care, risk adjustment, HEDIS, or delegated/capitated billing models.</li>
<li style="margin: 0in 0in 3pt 0px; font-size: 10.5pt; font-family: Calibri, sans-serif; color: #262626;">Experience with encounter data reporting or non-standard (non-FFS) claim types.</li>
<li style="margin: 0in 0in 3pt 0px; font-size: 10.5pt; font-family: Calibri, sans-serif; color: #262626;">Familiarity with payer portals for claim status verification.</li>
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