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.

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

Billing & Claims Analyst

Responsibilities

Qualification

Required

Preferred

Company

Porter

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