Senior Health Benefit Plan Consulting Attorney

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

📋 Description

• Oversee and provide assistance with the evaluation of member and provider appeals, grievances, and intricate claims matters, especially in self-funded and ERISA-regulated plans.

• Assess benefit exclusions, terms of plan documents, and disputes over medical necessity to ascertain suitable claim resolutions.

• Collaborate with relevant vendors to guarantee prompt and precise execution of independent clinical assessments.

• Scrutinize determination letters, responses to appeals, and other communications directed at members/providers for legal adequacy and adherence to regulations.

• Aid in internal audits, agency audits, corrective action plans, and requests from external regulators or clients.

• Conduct legal research pertaining to applicable laws and regulations; draft consulting memoranda; and offer consultative insights and analyses to the legal team.

• Review contracts within the healthcare sector.

• Address client inquiries regarding agency regulations, statutory obligations, and legal compliance.

• Engage with health plan administrators and other entities in the healthcare sector via phone, video conference, or face-to-face interactions.

• Respond to inquiries about compliant health plan administration and clarify relevant legal or health plan terminology.

• Prepare ERISA- and ACA-compliant health plan documents, including reports mandated by MHPAEA.

• Assist in settling disputes among participants in the healthcare industry.

• Analyze health plans and associated documents, summarizing insights for the legal team.

• Carry out other responsibilities as assigned.

⛳️ Requirements

• Juris Doctor degree from an accredited law school and active membership in a state bar.

• 3-7 years of preferred experience in the healthcare sector or similar fields (e.g., employment law, insurance law, disability law, workers’ compensation law).

• Awareness of recent developments in health law, including a functional understanding of the ACA, ERISA, MHPAEA, and HIPAA.

• Exceptional legal writing, analytical, and proofreading abilities, coupled with a keen attention to detail.

• Excellent organizational, interpersonal, and negotiation skills.

• Capability to work collaboratively or independently when necessary, while handling confidential matters with sensitivity.

• Proficient in effectively communicating and interacting with various roles within our organization as well as with clients.

• Skilled in managing multiple projects concurrently.

• Competent in participating effectively and confidently in client phone calls, including occasional video conferences.

• Ability to foresee challenges and devise methods to optimize outcomes and minimize risks.

• Capacity to gain a thorough understanding of business and operational objectives.

• Comfortable operating in a dynamic, fast-paced setting.

• High proficiency in Microsoft Word, Excel, and Outlook.

• Self-motivated with the ability to meet deadlines under pressure.

• Excellent academic credentials.

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

• Familiarity with administrative guidelines issued by relevant federal agencies, including HHS, the DOL, and the IRS.

• Knowledge of CMS billing and payment regulations and processes, or general familiarity with medical coding.

• Confidence in public speaking.

• Willingness to travel.

🏝️ Benefits

• Exceptional benefits for yourself.

• Commitment to equal opportunity employment.

• Reasonable accommodations provided as necessary under the ADA.