This is a fully remote position, open to applicants in Kentucky.

📋 Description

• Oversee a daily inventory of unpaid claims and disputes related to claims.

• Evaluate and prioritize claims according to processing guidelines, timelines, client needs, and service level expectations.

• Communicate with facilities and providers to discuss adjustments to charges and their rationale.

• Engage with facilities to clarify benefits and resolve payment discrepancies.

• Compose correspondence related to settlement discussions and negotiation efforts for providers and other stakeholders.

• Document detailed notes during calls for future reference.

• Address member inquiries in line with their medical plan as required.

• Collaborate with The Phia Group’s legal team to ensure claims are escalated appropriately.

• Contribute to continuous process improvements aimed at enhancing the efficiency of the claims settlement process.

• Assist the team with No Surprises Act initiatives, including reviewing medical claims, monitoring strict deadlines, drafting settlement agreements, and preparing submissions for Independent Dispute Resolution.

• Provide support for balance billing and overpayment issues as necessary.

⛳️ Requirements

• Preferred: Bachelor's degree (BA/BS) from a recognized college or university.

• Preferred: Experience in a healthcare claims role, particularly in negotiation, or experience with an insurance company, TPA, or hospital, especially focusing on claims, fee schedules, or contracting.

• Proficient in computer use, including Microsoft Office applications.

• Excellent oral and written communication abilities.

• Capable of multitasking in a fast-paced, dynamic environment.

• Competent in handling confidential information in compliance with HIPAA regulations.

• Able to perform essential job functions independently or with reasonable accommodations.

• Capacity to sit at a workstation for extended periods and perform extensive computer work.