NSA Claims Coordinator

The Phia Group•Canton, MA

4d•Onsite

About The Position

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 families, you can look forward to not only unparalleled benefits for yourself but also being immersed in a company that was named one of USA Today�s Top Workplaces for 2025 . Meanwhile, from a regional perspective, both The Boston Globe and Louisville Business First also recognized our unwavering commitment to upholding an internal culture of inclusivity, enjoyment, and empathy for our valued employees by listing The Phia Group in their respective lists for the Top Places to Work in 2025. The Provider Relations 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.

Requirements

Baccalaureate degree (BA/BS) from an accredited college or university.
Minimum of two years experience in a medical healthcare claims role, preferably involving negotiation, or experience at an insurance company, TPA, or hospital, preferably with emphasis in claims, fee schedules, or contracting.
Computer literate, including Microsoft Office products.

Responsibilities

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.
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).