NSA Claims Coordinator

Provider Relations 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 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.

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.
• 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

• Preferred: 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.

Working Conditions / Physical Demands

Sitting at workstation for prolong periods of time. Extensive computer work. Workstation may be exposed to overhead fluorescent lighting and air conditioning. Fast paced work environment. Operates office equipment including personal computer, copiers, and fax machines.

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

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

Salary: $50,000 - $55,000