Please note this position can become Hybrid after the probationary period review. Relocation bonus for qualified candidates upon approval.SUMMARY:This position is responsible for settling a high volume of claims using creative, innovative, and flexible argumentation; managing an ample case load of corporate health claims; filing written appeals through administrative appeals processes to resolve problematic (e.g. underpaid or denied) medical claims for payment with governmental and corporate health payers.
DUTIES AND RESPONSIBILITIES:- Quickly and efficiently review medical records and submit well-written compelling appeals to health insurers and governmental payers.
- Write demand letters and negotiate settlements from large corporate payers.
- Apply an expert understanding of Commercial, Governmental, Managed Care, and ERISA regulations regarding payment, coverage, conditions of participation, and other relevant topics to support appeal arguments.
- Assist legal appeals team in developing new and innovative legal and procedural arguments and tools.
- Oversee drafting of complex contractual appeals and administrative templates for organizational use.
- Guide legal interns and paralegals when needed.
- Perform administrative duties or projects as assigned by leadership.
- Navigate through various insurance systems and applications to find information about insurance claims.
- Follow all HIPAA guidelines and internal compliance protocols.
REQUIRED QUALIFICATIONS:- Juris Doctoral Degree (J.D.) from an American Bar Association accredited law school.
- Licensed to practice law in at least one U.S. jurisdiction (DC, MD, VA, or PA preferred).
- Law school GPA of 3.0 or higher.
- 3+ years of legal experience, ideally in healthcare or administrative law.
- Proficiency in Microsoft Office, including Word and Excel, with the ability to quickly learn and operate new computer programs and software.
- Highly attentive to detail and able to handle large amounts of paperwork for a busy office.
- Clear, concise, and logical writing style.
- Excellent organizational and time management skills.
PREFERRED QUALIFICATIONS:- Basic working knowledge of medical terminology and diagnostic procedures.
- Experience in healthcare claims, denial management, or reimbursement.
- Ability to work independently and efficiently with minimal supervision.
- Strong written and verbal communication.
- Dependability and sound judgement in time-sensitive matters.
- Team player with collaborative, feedback-oriented mindset.
COMPETENCIES:- Adaptability - Adapts to changes in the work environment; Manages competing demands; Changes approach or method to best fit the situation; Able to deal with frequent change, delays, or unexpected events.
- Analytical - Synthesizes complex or diverse information; Collects and researches data; Uses intuition and experience to complement data; Designs work flows and procedures.
- Attendance/Punctuality - Is consistently at work and on time; Ensures work responsibilities are covered when absent; Arrives at meetings and appointments on time
- Customer Service - Manages difficult or emotional customer situations; Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance; Meets commitments.
- Dependability - Follows instructions, responds to management direction; Takes responsibility for own actions; Keeps commitments; Commits to long hours of work when necessary to reach goals; Completes tasks on time or notifies appropriate person with an alternate plan
- Judgement - Displays willingness to make decisions; Exhibits sound and accurate judgment; Supports and explains reasoning for decisions; Includes appropriate people in decision-making process; Makes timely decisions.
- Problem Solving - Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions; Works well in group problem solving situations; Uses reason even when dealing with emotional topics
- Strategic Thinking - Develops strategies to achieve organizational goals; Understands organization's strengths & weaknesses; Analyzes market and competition; Identifies external threats and opportunities; Adapts strategy to changing conditions.
- Teamwork - Balances team and individual responsibilities; Exhibits objectivity and openness to others' views; Gives and welcomes feedback; Contributes to building a positive team spirit; Puts success of team above own interests; Able to build morale and group commitments to goals and objectives; Supports everyone's efforts to succeed.
BENEFITS:- Competitive salary based on experience with opportunity for performance-based bonuses
- Health, dental, and vision insurance stipend - Choose your own plan (in process of conversion to group health so this is changing)
- 401(k) retirement plan with company contribution
- Vacation time, sick time, and paid holidays
- Professional development and training opportunities
- Subsidized Life and disability insurance
- Commuter benefits
