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Years of Experience
Date Last Verified
ProfileHealth Insurance Regulatory, Corporate Counsel The candidate will support the company's Compliance and Regulatory Affairs teams, as well as several local markets across company's growing national footprint. Will report to the Vice President, Assistant General Counsel, Litigation and Regulatory. Support the Legal department and company business clients in providing legal advice and solutions on complex state and federal regulatory issues, including Medicare, Medicaid, CHIP programs, HIPAA, data privacy, health care operations, DOI and other regulatory regimes. Provide legal counsel on federal and state regulatory inquiries, audits, hearings and investigations, including drafting of and consultation on responses and discovery, advising on privilege, scope and other regulatory engagement issues, preparing witnesses, statements and testimony and directly engaging with regulators as required. Provide proactive Legal counsel and support for Regulatory Affairs team in monitoring and analyzing emerging regulatory issues/developments. Provide legal counsel on various regulatory requirements related to overall company business operations, including health care provider relationships, utilization and medical management, claims/appeals and data privacy and security issues.
Qualification and Experience
The candidate should be a member in good standing of a relevant State Bar. Must have strong academic credentials and 5+ years of legal experience in national law firm or in-house settings, with demonstrated expertise in developing and implementing strategic, proactive legal solutions on a range of regulatory issues impacting health insurance and managed care businesses. Experience with regulatory regimes and issues for Medicare, Medicaid, state CHIP programs, DOI regulation and general and health care data privacy/HIPAA, plus front-line experience with formal and informal federal and state regulatory inquiries, audits, hearings and investigations strongly preferred. Experience in various regulatory aspects related to health care provider relationships, utilization and medical management and claims/appeals desired. Litigation/dispute management and/or health insurance Compliance function experience a plus. Periodic travel may be required.
Ref. #: 1703466