Senior Healthcare Attorney

🔥 48 minutes ago

🇺🇸 United States – Remote

💵 $125k - $160k / year

⏰ Full Time

🟠 Senior

🧑‍💼 Attorney / Lawyer

👻 Ghost score 0%

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The Phia Group, LLC

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 2000

💼 Consulting

🏥 Healthcare

🛡️ Insurance

💰 Private Equity Round on 2018-09

Consulting • Healthcare • Insurance

The Phia Group, LLC is a dedicated provider of healthcare cost containment solutions, focusing on empowering self-funded health plans to maximize benefits and minimize costs. Through a comprehensive suite of services, including subrogation and recovery, claims negotiation, and cost transparency initiatives, The Phia Group aims to help employers and families navigate the complexities of healthcare with advocacy and expertise. Their commitment to improving healthcare accessibility and affordability sets them apart in the industry.

📋 Description

• Manage and support reviews of member and provider appeals, grievances, and complex claims issues, particularly for self-funded and ERISA-regulated plans • Evaluate benefit exclusions, plan document terms, and medical necessity disputes to determine claim outcomes • Coordinate with vendors to facilitate independent clinical reviews • Review determination letters, appeal responses, and member/provider communications for legal sufficiency and regulatory compliance • Support internal and agency audits, corrective action plans, and external regulator or client requests • Conduct legal research and draft consulting memoranda • Provide consultative legal advice and analyses to the legal team • Review healthcare industry contracts • Respond to client inquiries regarding agency rules, statutory requirements, and legal compliance • Communicate with health plan administrators and healthcare industry entities regarding compliant health plan administration and applicable law • Draft ERISA- and ACA-compliant health plan documents, including MHPAEA required reports • Assist in resolving disputes among healthcare industry participants • Analyze health plans and related documents and summarize findings for the legal team • Perform other duties as assigned

🎯 Requirements

• Juris doctor from an accredited law school • Active admission to a state bar • 3–7 years of experience in the healthcare industry or similar industries preferred • Knowledge of current health law developments, including ACA, ERISA, MHPAEA, and HIPAA • Superior legal writing, analytical, and proofreading skills • Strong attention to detail • Organizational, interpersonal, and negotiation skills • Ability to work collaboratively or independently and handle confidential matters • Ability to communicate effectively with organizational positions and clients • Ability to manage multiple projects simultaneously • Ability to participate effectively in client phone and occasional video conference calls • Ability to anticipate issues and optimize results while minimizing risks • Ability to understand the business and operational goals • Comfort working in a fast-paced environment • High proficiency with Microsoft Word, Excel, and Outlook • Self-motivated and able to meet deadlines under pressure • Preferred: excellent academic credentials • Preferred: experience with health plans, third-party administrators, and/or health insurance carriers • Preferred: familiarity with administrative rules from HHS, DOL, and IRS • Preferred: knowledge of CMS billing and payment rules, processes, or medical coding • Preferred: public speaking confidence • Willingness to travel

🏖️ Benefits

• Exceptional benefits • Equal opportunity employer committed to diversity and inclusion • Reasonable accommodation for disabilities • Potential travel opportunities

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