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The Phia Group, LLC · 13 hours ago

ERISA Health Plan Attorney ($90K - $120K)

Canton, MA

Full-time

Hybrid

Entry Level

$90K/yr - $120K/yr

1+ years exp

The Phia Group, LLC is a thriving, service-oriented company headquartered in Canton, Massachusetts, seeking to add a Health Benefits Attorney to their team. The Attorney will support consulting services and the growth of the business by managing legal matters related to healthcare plans, compliance, and regulatory issues.

ConsultingFinancial ServicesInformation TechnologyLegal

Responsibilities

Manage and support reviews of member and provider appeals, grievances, and complex claims issues, particularly in self-funded and ERISA-regulated plans

Evaluate benefit exclusions, plan document terms, and medical necessity disputes to determine appropriate claim outcomes

Coordinate with applicable vendors to ensure timely and accurate facilitation of independent clinical reviews

Review determination letters, appeal responses, and other member/provider-facing communications to ensure legal sufficiency and regulatory compliance

Support internal audits, agency audits, corrective action plans, and external regulator or client requests, ensuring regulatory compliance

Conduct legal research on applicable law and regulations; draft consulting memoranda; provide consultative advice, including analyses to our legal team for internal use

Review healthcare industry contracts

Respond to client inquiries regarding agency rules, statutory requirements, and legal compliance

Communicate 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 concisely

Draft ERISA and ACA-compliant health plan documents

Assist in resolving disputes between various players in the healthcare industry

Provide a thorough analysis of health plans and other related documents; provide a summary of findings to our legal team

Other duties as assigned

Qualification

ERISA knowledgeHealthcare industry experienceLegal writing skillsRegulatory complianceJuris Doctor degreeAnalytical skillsMicrosoft Office proficiencyNegotiation skillsPublic speakingInterpersonal skillsOrganizational skillsAttention to detail

Required

Juris 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, and HIPAA

Superior legal writing, analytical, and proofreading skills, as well as strong attention to detail

Outstanding organizational, interpersonal, and negotiation skills

Ability to work collaboratively or independently as needed, and to work sensitively with confidential matters

Ability to effectively communicate and interact with various positions throughout our organization as well as with clients

Ability to successfully manage multiple projects, whether large or small, complex or simple, simultaneously

Ability to participate effectively and confidently in client phone calls, including in occasional video conference calls

Ability to anticipate issues and create and implement methods for optimizing results and minimizing risks

Ability to develop a deep understanding of the business and our operational goals

Comfortable working in a fast-paced environment

High level of proficiency using Microsoft Word, Excel and Outlook

Must be self-motivated and able to meet deadlines under pressure

Preferred

Excellent academic credentials

Strong preference for experience working with health plans, third-party administrators, and/or health insurance carriers

Familiarity with administrative rules published by relevant federal agencies, including HHS, the DOL, and the IRS

Knowledge of CMS billing and payment rules and processes, or medical coding generally

Confidence in public speaking

Willingness to travel

Company

The Phia Group, LLC

The 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.

Founded in 1999

Braintree, Massachusetts, USA

201-500 employees