Revenue Cycle & Claims Operations Lead

Porter is hiring a Revenue Cycle & Claims Operations to join our Team! Porter 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 — 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, flagg...