Porter logo
Porter

Your Care, Our Passion. Your Health, Our Priority.

Revenue Cycle Lead

Revenue OperationsRevenue OperationsFull TimeRemoteSeniorTeam 51-200H1B SponsorCompany SiteLinkedIn

Location

Florida

Posted

4 days ago

Salary

$115K - $150K / year

Seniority

Senior

Bachelor Degree5 yrs expEnglish

Job Description

Revenue Cycle Lead

Porter

• Serve as the primary internal owner of Athena claim edit rules, hold queues, and workflow configuration as they relate to our non-FFS billing model. • 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. • Translate payer contract terms (rate structures, encounter-reporting requirements, invoicing arrangements) into correct system configuration. • Maintain a living documentation set of every custom rule, workaround, and configuration decision made in Athena, including rationale and payer applicability. • Ensure claims are reaching payers as intended and reconcile discrepancies between what was submitted, what was accepted, and what was paid or invoiced. • Identify and clear inappropriate Athena holds; distinguish true data/coding issues from false positives generated by FFS-oriented logic. • Track and resolve partial payments, particularly where Athena's allowable-amount logic conflicts with contracted full-payment terms. • Oversee the separate plan-invoicing process for encounter/penny-claim arrangements, ensuring invoices reconcile against submitted encounters. • 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. • Lead a structured 90-day assessment of Athena's fit for our billing model and deliver a clear recommendation: continue to mitigate within Athena or scope a transition to an alternative platform.

Job Requirements

  • 5+ years of revenue cycle management or claims operations experience in healthcare.
  • Direct, hands-on experience with value-based care, risk adjustment, HEDIS/quality gap closure, delegated services, or other non-fee-for-service payer arrangements.
  • Practical experience configuring Athena (or a comparable EMR/RCM platform), including working with vendor support/professional services teams on custom edit rules and workflow changes.
  • Ability to read and interpret payer contract language and translate contractual terms into system requirements.
  • Strong analytical and reporting skills; comfortable building reconciliation reports and communicating findings to finance leadership.
  • 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.

Benefits

  • Competitive wage and benefits package.
  • Opportunities for professional growth and continuing education.
  • A supportive, collaborative work environment.

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