Paralegal IV

This is a fully remote position, open to applicants in United States.

📋 Description

• Oversee impartial legal and adjudicative assistance for CMS Office of Hearings operations, mainly focusing on Medicare Advantage Risk Adjustment Data Validation appeals.

• Investigate intricate issues and consolidate findings from various disciplines.

• Compose clear and defensible recommendations along with proposed decisions for the CMS Hearing Officer.

• Examine RADV appeal requests, briefs, motions, hearing records, and accompanying documentation.

• Research and implement statutes, regulations, CMS guidance, policies, procedures, and precedents.

• Draft and evaluate legal memoranda, orders, notices, recommendations, and proposed decisions.

• Assess jurisdictional, procedural, and substantive matters, escalating significant risks or deficiencies as necessary.

• Combine legal, medical, coding, and case management insights into neutral, well-founded recommendations.

• Conduct final quality assessments and provide guidance to legal support staff.

• Collaborate with CMS and project leadership.

• Ensure compliance in case record maintenance.

⛳️ Requirements

• A Bachelor’s degree in legal studies, paralegal studies, health policy, public administration, or a relevant field, or equivalent education and experience.

• Over 10 years of progressively responsible experience in legal, regulatory, compliance, administrative appeals, or healthcare policy.

• At least 5 years of experience in drafting or substantively reviewing legal briefs, memoranda, recommendations, proposed decisions, orders, opinions, or similar analytical work products.

• Familiarity with Medicare or Medicaid law, healthcare appeals, managed care, or regulatory oversight.

• Strong skills in complex legal research, neutral analysis, decision writing, quality review, communication, organization, and meeting deadlines.

• Proficient in Microsoft Office and legal, document, or case management systems.

• Capability to secure necessary suitability and system access.

• Juris Doctor degree from an accredited law school and active bar admission in a U.S. jurisdiction is preferred.

• Background in administrative hearings, appeals, adjudications, decision writing, or judicial clerkship work is preferred.

• Experience assisting federal hearing officers or administrative law judges is preferred.

• Direct experience with CMS appeals, Medicare Advantage, RADV, or healthcare regulatory adjudication is preferred.

🏝️ Benefits

• Recognition as a 2024 Military Friendly Employer.

• Hiring and promotion decisions based on merit.

• Support for active-duty and veteran employees.