Senior Healthcare Attorney

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

📋 Description

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

• Assess benefit exclusions, terms outlined in plan documents, and disputes regarding medical necessity to ascertain claim resolutions.

• Collaborate with vendors to enable independent clinical evaluations.

• Scrutinize determination letters, appeal responses, and communications with members/providers for legal adequacy and compliance with regulations.

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

• Perform legal research and compose consulting memoranda.

• Offer consultative legal insights and analyses to the legal team.

• Examine contracts within the healthcare sector.

• Address client queries concerning agency regulations, statutory obligations, and legal adherence.

• Engage with health plan administrators and entities within the healthcare industry regarding compliant health plan management and relevant laws.

• Draft health plan documents that comply with ERISA and ACA, including reports mandated by MHPAEA.

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

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

• Carry out additional responsibilities as assigned.

⛳️ Requirements

• Juris Doctor degree from an accredited law institution.

• Active membership in a state bar.

• 3–7 years of experience in the healthcare sector or related fields is preferred.

• Familiarity with current health law advancements, such as ACA, ERISA, MHPAEA, and HIPAA.

• Exceptional legal writing, analytical, and proofreading abilities.

• Strong attention to detail.

• Excellent organizational, interpersonal, and negotiation skills.

• Capability to work both collaboratively and independently while managing confidential information.

• Proficiency in effectively communicating with organizational roles and clients.

• Ability to handle multiple projects concurrently.

• Competence in participating effectively in client phone and occasional video conference discussions.

• Capacity to foresee issues and enhance outcomes while mitigating risks.

• Understanding of business and operational objectives.

• Comfort in a dynamic, fast-paced work environment.

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

• Self-driven and capable of meeting deadlines under pressure.

• Preferred: Strong academic credentials.

• Preferred: Experience with health plans, third-party administrators, and/or health insurance providers.

• Preferred: Knowledge of administrative regulations from HHS, DOL, and IRS.

• Preferred: Understanding of CMS billing and payment regulations, processes, or medical coding.

• Preferred: Confidence in public speaking.

• Willingness to travel.

🏝️ Benefits

• Outstanding benefits.

• Equal opportunity employer dedicated to diversity and inclusion.

• Reasonable accommodations for disabilities.

• Possible travel opportunities.