Global Reimbursement & Complex Claims Negotiator

The Phia Group, LLC; Bowling Green (KY); Vor Ort; USD 55.000 - 65.000; Vollzeit

Zusammenfassung

The Phia Group, LLC in Bowling Green, KY is seeking a Reimbursement and Complex Claims Analyst to negotiate reimbursement terms with facilities and providers for domestic and international clients. You will support the reimbursement team with daily tasks and handle high‑exposure claims under tight deadlines.

Ideal candidates have healthcare claims experience, knowledge of fee schedules and coding concepts, strong communication and data literacy, and the ability to manage multiple tasks in a fast

Qualifikationen

• Bachelor’s degree from an accredited college or university.
• AAPC CPC credential or comparable coding and reimbursement expertise.
• Experience in medical healthcare claims with negotiation/reimbursement focus.
• Knowledge of reimbursement methodologies, fee schedules, coding, and contracting.

Aufgaben

• Negotiate agreements with facilities/providers to establish reimbursement terms.
• Manage daily pre-service requests, pre-claim matters, unpaid claims, and disputes.
• Review matters based on processing criteria, timelines, client demands, and financial exposure.
• Contact facilities/providers to discuss reimbursement arrangements and rationale.
• Draft correspondence and agreements related to negotiation and settlement efforts.
• Capture detailed notes on calls/negotiations for internal/external reference.
• Handle complex/high-dollar claims under sensitive timelines and escalate issues.
• Collaborate with Provider Relations escalation team and legal department.
• Support repricing, research, claim review, system updates and tasks.
• Maintain centralized data repository integrity (fee schedules, crosswalk tables).
• Assist with client configurations and new client implementations.
• Participate in projects focused on coding, benchmarking, and reimbursement.
• Maintain/update standard operating procedures under Provider Relations management.
• Handle confidential information per HIPAA.

Kenntnisse

Negotiation

Communication

Problem-solving

Data literacy

Organization

Microsoft Office

Ausbildung

Bachelor's degree (BA/BS)

CPC credential

Tools

Microsoft Office

Jobbeschreibung

The Phia Group, LLC in Bowling Green, KY is seeking a Reimbursement and Complex Claims Analyst to negotiate reimbursement terms with facilities and providers for domestic and international clients. You will support the reimbursement team with daily tasks and handle high‑exposure claims under tight deadlines.

Ideal candidates have healthcare claims experience, knowledge of fee schedules and coding concepts, strong communication and data literacy, and the ability to manage multiple tasks in a fast