Provider Relations Claims Coordinator

The Phia Group is a service-oriented consultant that assists health plans nationwide. We provide our clients with innovative cost-cutting solutions and innovative service offerings. As employers seek to identify reasonable prices for healthcare while protecting their employees against abusive practices, they encounter conflicts from many directions. One area of concern in particular is balance-billing : the practice by some providers of medical services to seek payment of amounts in excess of payments made by health plans, from patients and / or employers.

At The Phia Group, whose mission is to provide high quality yet affordable healthcare to American employees and their dependents, you can look forward to not only exceptional benefits for yourself but also being immersed in a company that has been named one of USA Today's top workplaces for 2024. We believe that this distinction, which stems from the fourth-annual survey co-sponsored by Energage and USA Today, reflects our unwavering commitment to upholding an internal culture of inclusivity, enjoyment, and empathy for our valued employees.

The Provider Relations Claims Coordinator will be responsible for negotiating settlement with facilities and providers on a national basis to reduce healthcare claims costs, among many other tasks, including being the point-person for the entire Provider Relations department. This position requires someone that is proactive, persuasive, persistent, respectful, assertive, and able to multitask.

Essential Duties and Responsibilities

include the following. Other duties may be assigned.

• Manage a daily running inventory of unpaid claims or claim disputes.
• Review and prioritize claims based on processing criteria, timelines, client demands, and service level standards.
• Verify and oversee importation of client data; perform periodic audits and corresponding reporting.
• Contact facilities and providers to discuss charge adjustments and rationale.
• Contact facilities and explain benefits to resolve payment disputes.
• Draft correspondence pertaining to settlement and negotiation efforts for providers and other entities.
• Capture detailed notes on calls for future reference.
• As needed, handle member inquires in accordance to their medical plan.
• Work with The Phia Group's legal department to ensure escalation of claims.
• Participate in on-going process improvement to develop efficiencies that streamline the claim settlement process.
• Ability to properly handle confidential information in accordance with the Health Insurance Portability and Accountability Act (HIPAA).

Experience and Qualifications

The Phia Group's Commitment to Diversity

The Phia Group is committed to creating a diverse environment and we are proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. The Phia Group is also committed to compliance with all fair employment practices regarding citizenship and immigration status.

Salary : $50,000 - $60,000 / year

Working Conditions / Physical Demands

This position requires sitting at a workstation for prolong periods of time (with reasonable breaks as needed) and extensive computer work. The workstation may be exposed to overhead fluorescent lighting and air conditioning. This is a fast-paced work environment in which you will be operating office equipment including personal computers, copiers, and fax machines.

External and internal applicants, as well as position incumbents who become disabled as defined under the Americans with Disabilities Act (ADA), must be able to perform the essential job functions (as listed herein) either unaided or with the assistance of a reasonable accommodation to be determined by management on a case-by-case basis.

This job description is not intended to be and should not be construed as an all-inclusive list of all of the job duties, skills, or working conditions associated with the position. While it is intended to accurately reflect the position's associated activities and requirements, the company reserves the right to modify, add, or remove duties and assign other duties as necessary.

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