Healthcare Attorney (Canton, MA - Hybrid)

The Phia Group, LLC is a thriving, service-oriented company headquartered in Canton, Massachusetts. They are seeking a Healthcare Attorney to support their consulting services and handle complex legal issues in the healthcare industry, working closely with other attorneys and consultants on various legal matters.ResponsibilitiesManage and support reviews of member and provider appeals, grievances, and complex claims issues, particularly in self-funded and ERISA-regulated plansEvaluate benefit exclusions, plan document terms, and medical necessity disputes to determine appropriate claim outcomesCoordinate with applicable vendors to ensure timely and accurate facilitation of independent clinical reviewsReview determination letters, appeal responses, and other member/provider-facing communications to ensure legal sufficiency and regulatory complianceSupport internal audits, agency audits, corrective action plans, and external regulator or client requests, ensuring regulatory complianceConduct legal research on applicable law and regulations; draft consulting memoranda; provide consultative advice, including analyses to our legal team for internal useReview healthcare industry contractsRespond to client inquiries regarding agency rules, statutory requirements, and legal complianceCommunicate with health plan administrators and other healthcare industry entities, including by phone, video conference, or in person; answer questions regarding the administration of compliant health plans; explain applicable law or health plan terms clearly and conciselyDraft ERISA and ACA-compliant health plan documents, including MHPAEA required reportsAssist in resolving disputes between various players in the healthcare industryProvide a thorough analysis of health plans and other related documents; provide a summary of findings to our legal teamOther duties as assignedSkillsJuris doctor from an accredited law school and admittance to a state bar (active)1+ year of experience in the healthcare industry or in similar industries preferred (i.e., employment law, insurance law, disability law, workers' compensation law)Knowledge of the latest developments in health law, including a working understanding of the ACA, ERISA, MHPAEA, and HIPAASuperior legal writing, analytical, and proofreading skills, as well as strong attention to detailOutstanding organizational, interpersonal, and negotiation skillsAbility to work collaboratively or independently as needed, and to work sensitively with confidential mattersAbility to effectively communicate and interact with various positions throughout our organization as well as with clientsAbility to successfully manage multiple projects, whether large or small, complex or simple, simultaneouslyAbility to participate effectively and confidently in client phone calls, including in occasional video conference callsAbility to anticipate issues and create and implement methods for optimizing results and minimizing risksAbility to develop a deep understanding of the business and our operational goalsComfortable working in a fast-paced environmentHigh level of proficiency using Microsoft Word, Excel and OutlookMust be self-motivated and able to meet deadlines under pressureExcellent academic credentialsStrong preference for experience working with health plans, third-party administrators, and/or health insurance carriersFamiliarity with administrative rules published by relevant federal agencies, including HHS, the DOL, and the IRSKnowledge of CMS billing and payment rules and processes, or medical coding generallyConfidence in public speakingWillingness to travelCompany OverviewThe Phia Group, LLC, headquartered in Canton, Massachusetts, is an experienced provider of health care cost containment techniques offering comprehensive consulting services, plan document drafting, subrogation and overpayment recovery, claim negotiation, plan defense, designed to control costs and protect plan assets. It was founded in 1999, and is headquartered in Braintree, Massachusetts, USA, with a workforce of 201-500 employees. Its website is http://phiagroup.com.



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