Revenue Cycle & Claims Operations Lead
PorterCloud Deployment/PaaS/DevOps company
Pompano Beach, United StatesLead
FirstMark Capital
Y Combinator
Venrock
Soma Capital
Translink Investment
Operations & Strategy
About the role
TL;DR
Lead Revenue Cycle & Claims Operations for non-FFS billing model.
- •Porter is hiring a Revenue Cycle & Claims Operations to join our Team! Our organization operates in a payer-contracted services model including delegated services, in-home assessments, HEDIS gap closure, and risk adjustment visits.
- •We are hiring a Revenue Cycle & Claims Operations Lead to own this problem end-to-end: 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.
- •Key Responsibilities 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.
- •Translate payer contract terms (rate structures, encounter-reporting requirements, invoicing arrangements) into correct system configuration.
- •Ensure claims are reaching payers as intended and reconcile discrepancies between what was submitted, what was accepted, and what was paid or invoiced.
- •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.
Required skills
Athena
Domain expertise
healthcare
Tech stack
Athena
