Billing and Claims Analyst

Job description

**Porter is hiring a Billing & Claims Analyst to join our Team!** **[Porter](http://www.helloporter.com)** 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. **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. 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. **KEY RESPONSIBILITIES** **Reporting & Reconciliation** - Build and maintain recurring reports in Athena covering claim submission status, hold/edit queues, and payment status. - Reconcile claims sent to payers against invoices sent separately for encounter/penny-claim arrangements, confirming amounts match and nothing has fallen through the cracks. - 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. - Maintain claim-aging reports so nothing sits in a hold queue unnoticed. **Claims Monitoring & First-Line Troubleshooting** - Monitor daily/weekly claim submission activity to confirm claims are actually reaching payers, not just leaving Athena. - 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. - 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. - Contribute claim-level detail to the 90-day Athena assessment and any future EMR evaluation. **REQUIRED QUALIFICATIONS** - 1–3+ years of experience in medical billing, claims processing, or revenue cycle operations. - Working proficiency in Athena (or comparable EMR/RCM system) — running reports, navigating claim status and hold queues, and pulling claim-level detail. - Strong Excel skills (pivot tables, VLOOKUP/XLOOKUP, basic reconciliation building); SQL or other data-query experience is a plus but not required. - High attention to detail and comfort with repetitive reconciliation work — this role lives in the data, not just the summary. - Clear written communication for documenting issues and escalations. **PREFERRED QUALIFICATIONS** - 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.