We are currently seeking a full time attorney with experience in this or similar industries, to solve issues presented by employers, their health plans, and those that service them; such as responding to audits, ensuring regulatory compliance, explaining plan terms, applicable laws, and resolving disputes between health plans, patients, and healthcare service providers – in an effort to protect plan members and sponsors. Duties will include conducting legal research, responding to questions regarding agency rules, statutory requirements, and legal compliance, communicating with plan administrators, and answering any number of questions regarding administration of compliant health plans in light of applicable rules and laws.
Essential Duties and Responsibilities include the following. Other duties may be assigned.
Assist legal staff with work associated with consultation of general health plan administration.
Draft ERISA and PPACA compliant documents.
Conduct legal research as assigned
Provide thorough analysis of benefit plans and other case related documents and provide summary of findings to legal department staff.
Research current laws and provide information to legal staff for internal use.
Assist Claim Recovery Specialist staff with complex subrogation case legal matters.
Experience and Qualifications
Degree from an accredited law school and admittance to a State Bar
Knowledge of latest developments in healthcare, the Patient Protection and Affordable Care Act, and ERISA
Must show demonstrable experience with, or interest (study) in, regulatory and agency law, including IRS, DOL, and HHS, especially as it relates to employee benefit plans
Excellent attention to detail with the ability to multi-task
Excellent analytical skills
Ability to scan relevant materials quickly and accurately
Ability to effectively communicate and interact with varied positions throughout the organization as well as
High level of proficiency using Microsoft Word, Excel and Microsoft Outlook required
Outstanding organizational, interpersonal and negotiation skills
Excellent telephone, writing and proofreading skills
Must be self-motivated and able to meet deadlines under pressure
Must have the ability to work as part of a team, as well as to work independently
Prior work with health benefit plans, third party administrators, and/or health insurance carriers
Proven record in managing cases involving Medicare and CMS, billing and payment rules and processes
Past work within or related to the healthcare and insurance industries
3-5 years experience relating to:
Health benefit plan administration
Hospital billing and payment rules and processes
Healthcare and ERISA law
Experience with healthcare regulatory / agency law, including IRS, DOL, and HHS