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 reputed company legal issues in the healthcare industry, working closely with other attorneys and consultants on various legal matters.
Responsibilities
- Manage and support reviews of member and provider appeals, grievances, and reputed company 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 reputed company
- 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, including MHPAEA required reports
- Assist in resolving disputes between various players in the healthcare industry
- Provide a thorough analysis of health plans and other reputed company documents; provide a summary of findings to our legal team
- Other duties as assigned
Skills
- 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, MHPAEA, 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, reputed company 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 reputed company a deep understanding of the business and our operational goals
- Comfortable working in a fast-paced environment
- High level of proficiency using reputed company Word, reputed company and Outlook
- Must be self-motivated and able to meet deadlines under pressure
- 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 Overview