Job Details

Associate General Counsel Payor Relations-Reimbursement & Litigation

Company name

Organization Type

In-House

Job Type

Attorney

Years of Experience

Min 15 yrs required

Location

Waltham, MA

Date Last Verified

Aug 20,2017

Posted on

Jul 08,2017
Practice Area
Litigation >> Litigation - Employment
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Associate General Counsel Payor Relations-Reimbursement & Litigation Duties: Acts as the primary manager of legal support related to payor/provider arrangements, which include analyzing reimbursement and overpayment disputes; managing reimbursement or overpayment litigation and arbitration; negotiating payor/provider contracts; analyzing issues related to insurance coverage and coordination; and providing general legal support for the company’s billing and collection functions. Oversees and manages a team of attorneys and paralegal. Provides practical, business-oriented strategic advice and counsel to help the company meet its business objectives through an in-depth understanding of the laws, rules and regulations applicable to FMCNA business, including MSP Act, ERISA, COBRA, Affordable Care Act, federal and state anti-kickback statutes, anti-self-referral statutes, false claims statutes, HIPAA/HITECH, and the CMP statute. Maintain a thorough understanding of the company’s business objectives and acts as a trusted business partner for senior management and the organization. Utilizes subject matter expertise in the areas of payor/provider contracting and reimbursement disputes to support the business. Builds coalitions and contributes to strategies based on an understanding of external and internal landscape. Represents the company in interactions with federal and state regulatory agencies. Reviews and advises on programs, initiatives, and contracts related to reimbursement issues and payor/provider arrangements. Reviews and advises on statutes and regulations related to provider reimbursement matters. Reviews and advises on promotional materials and corporate communications. Provides project management, due diligence and integration support in connection with business development transactions. Maintains current knowledge of all significant legislative and regulatory developments that may affect the company in the areas of healthcare and business law. Communicates changes in legislation and regulation to the organization as is appropriate. Establishes and maintains positive supportive relationships with business unit management and personnel at all levels. Provides a variety of legal counsel and support to functional and/or operational groups within the company. Provides day to day guidance, support, training and assistance to staff in the legal department, providing oversight support, mentoring assigned staff, and collaborating with them to develop objectives and goals for the department and also as part of continued career development and advancement within the organization. Oversees departmental workflow procedures and service levels. Reviews ongoing analysis and assessments of performance. Provides informal feedback on an ongoing basis and formal feedback in the annual performance evaluation process, counseling and working with the staff member to establish individual short term and long term performance goals. Manages the staffing through the appropriate hiring, firing and disciplinary actions in collaboration with Human Resource partners. Develops, implements and maintains departmental processes and procedures to enhance the overall efficiency of the department. Manages external legal counsel and other outsourced resources involved in key company projects to optimize project outcomes. Assist with various projects as assigned. Other duties as assigned.

Qualification and Experience

Qualifications: JD Degree from an accredited college or university required. 15+ years of experience practicing law, either at a law firm, in house or a combination thereof. 10+ years (of the 15+ years) of experience practicing law in the healthcare industry, either at a law firm, in house, or a combination thereof, advising on legal issue related to payor/provider arrangements, including both litigation and contracting. Detail-oriented with very strong oral and writing skills. Highly developed strategic and conceptual/analytical skills. Experience with MSP Act, ERISA, and ACA preferred. In-house experience with a healthcare provider preferred. Understanding of healthcare provider claims processing, billing and collections preferred. Experience managing legal professionals preferred. Able and willing to lead key initiatives and participate in teams driving key decisions preferred. A strong intellect and solid business acumen, coupled with the skills of a pragmatic business leader preferred. Superior communication and interpersonal skills and demonstrated success in the ability to relate to many different constituencies preferred. Ability to work in a fast-changing, intense working environment. Makes decisions with a sense of urgency, prioritizing possibilities and opportunities, and balancing information seeking with acting quickly.

Additional info

Job ID: 17000EKS

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