Strategic Reimbursement & Complex Claims Analyst

The Phia Group; Kentucky; On-site; USD 60,000 - 85,000; Full time

Job summary

The Phia Group in Kentucky is seeking a Reimbursement and Complex Claims Analyst to negotiate terms with facilities and providers for domestic and international clients, while supporting the reimbursement team with daily tasks. You will handle complex claims, assist with research, client configurations, and process improvements in a fast-paced environment.

Ideal candidates have a BA/BS and/or CPC certification with experience in healthcare claims, reimbursement concepts, and strong communication

Qualifications

• Baccalaureate degree (BA/BS) preferred.
• AAPC CPC credential or comparable coding and reimbursement expertise.
• Experience in medical healthcare claims, negotiations, or complex claims.
• Knowledge of reimbursement methodologies and fee schedules.
• Strong communication and problem-solving skills.

Responsibilities

• Negotiate reimbursement terms with facilities and providers.
• Manage daily pre-service requests, pre-claim matters, unpaid claims, and disputes.
• Review matters and prioritize based on processing criteria and client demands.
• Draft correspondence and agreements pertaining to negotiation and settlement efforts.
• Capture detailed notes on calls and negotiations for internal and external use.
• Support repricing, research, and system updates for reimbursement operations.
• Maintain HIPAA-compliant handling of confidential information.

Skills

Negotiation

Communication

Data literacy

Analytical skills

Education

BA/BS degree

AAPC CPC

Job description

The Phia Group in Kentucky is seeking a Reimbursement and Complex Claims Analyst to negotiate terms with facilities and providers for domestic and international clients, while supporting the reimbursement team with daily tasks. You will handle complex claims, assist with research, client configurations, and process improvements in a fast-paced environment.

Ideal candidates have a BA/BS and/or CPC certification with experience in healthcare claims, reimbursement concepts, and strong communication