We are currently seeking a full-time
Sr. Health Benefit Plan Consulting Attorney with professional experience in the healthcare industry or in similar industries to solve complex issues presented by employers, their health plans, and those entities that service them. The Health Benefits Attorney will play an instrumental role in supporting our consulting services and the continued growth and expansion of our business. This individual will work closely with other attorneys and consultants on our legal team, providing support on consulting, transactional, regulatory, and compliance matters.
Essential Duties:
- Manage and support reviews of member and provider appeals, grievances, and complex claims issues, particularly in self-funded and ERISA-regulated plans
- Evaluate benefit exclusions, plan document terms, and medical necessity disputes to determine appropriate claim outcomes
- Coordinate with applicable vendors to ensure timely and accurate facilitation of independent clinical reviews
- Review determination letters, appeal responses, and other member/provider-facing communications to ensure legal sufficiency and regulatory compliance
- Support internal audits, agency audits, corrective action plans, and external regulator or client requests, ensuring regulatory compliance
- Conduct legal research on applicable law and regulations; draft consulting memoranda; provide consultative advice, including analyses to our legal team for internal use
- Review healthcare industry contracts
- Respond to client inquiries regarding agency rules, statutory requirements, and legal compliance
- Communicate with health plan administrators and other healthcare industry entities, including by phone, video conference, or in person; answer questions regarding the administration of compliant health plans; explain applicable law or health plan terms clearly and concisely
- Draft ERISA and ACA-compliant health plan documents, including MHPAEA required reports
- Assist in resolving disputes between various players in the healthcare industry
- Provide a thorough analysis of health plans and other related documents; provide a summary of findings to our legal team
- Other duties as assigned
Minimum Qualifications:
- Juris doctor from an accredited law school and admittance to a state bar (active)
- 3-7 years of experience in the healthcare industry or in similar industries preferred (i.e., employment law, insurance law, disability law, workers' compensation law)
- Knowledge of the latest developments in health law, including a working understanding of the ACA, ERISA, MHPAEA, and HIPAA
- Superior legal writing, analytical, and proofreading skills, as well as strong attention to detail
- Outstanding organizational, interpersonal, and negotiation skills
- Ability to work collaboratively or independently as needed, and to work sensitively with confidential matters
- Ability to effectively communicate and interact with various positions throughout our organization as well as with clients
- Ability to successfully manage multiple projects, whether large or small, complex or simple, simultaneously
- Ability to participate effectively and confidently in client phone calls, including in occasional video conference calls
- Ability to anticipate issues and create and implement methods for optimizing results and minimizing risks
- Ability to develop a deep understanding of the business and our operational goals
- Comfortable working in a fast-paced environment
- High level of proficiency using Microsoft Word, Excel and Outlook
- Must be self-motivated and able to meet deadlines under pressure
Preferred Qualifications:
- Excellent academic credentials
- Strong preference for experience working with health plans, third-party administrators, and/or health insurance carriers
- Familiarity with administrative rules published by relevant federal agencies, including HHS, the DOL, and the IRS
- Knowledge of CMS billing and payment rules and processes, or medical coding generally
- Confidence in public speaking
- Willingness to travel
Working Conditions/Physical Demands
This position requires sitting at a workstation for prolong periods of time (with reasonable breaks as needed) and extensive computer work. The workstation may be exposed to overhead fluorescent lighting and air conditioning. This is a fast-paced work environment in which you will be operating office equipment including personal computers, copiers, and fax machines.
This job description is not intended to be and should not be construed as an all-inclusive list of all of the job duties, skills, or working conditions associated with the position. While it is intended to accurately reflect the position's associated activities and requirements, the company reserves the right to modify, add, or remove duties and assign other duties as necessary.
Base Salary: $125,000 - $160,000
