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Years of Experience
Date Last Verified
ProfileSenior Counsel Duties: Supports all operations groups requiring legal guidance, serving as counsel in matters relating to contract review and development, government and non-government payor reimbursement issues relating to clients and operations, and in matters relating to vendor and supplier relationships. Provides interpretive guidance and operations support relating to payor reimbursement rules and regulations, as well as other government programs, and with commercial payor contracts and company policies and procedures across all operations groups and other revenue cycle activities. Supports operations, especially focused on CMS Cap Management Systems (CAP) and including the National Insurance Center (NIC), relating to regulatory matters, contract interpretation and guidance relating to company and client vendors and suppliers, particularly relating to contract obligations and company policies and procedures and such other activities as may be directed by the VP/Chief Legal Officer. Provide review, interpretation, analysis and guidance regarding federal and state payor programs and other state and federal government directives relating to revenue cycle activities. Support contract development and approval related to company operations and client support. Support Sourcing Management, ensuring successful and accurate incorporation of vendor relationships for clients. Support reimbursement and regulatory imperatives as they relate to policies and procedures, thereby reducing compliance and legal risks. Support of terms and conditions groups and subsidiary operators relating to interpretation of contracts, payor fee schedules and directives and government payor program directives as they impact company operations and compliance and regulatory governance. Assist with the interpretation of payor fee schedules, including governmental and non-governmental payors and ensure that managed care contracts are accurately interpreted by operations. Support operations in resolution of issues with all payor types. Assist assigned operations units in developing solutions relating to client arrangements and Sourcing Management imperatives, increasing productivity and efficiency. Assist in drafting policies and review and revise, as needed, current policies and procedures to bring them into compliance with law and regulation, working collaboratively with the Compliance Department. Interpret client policies, procedures and contracts to ensure compliance with Conifer workflows. Assist in review, negotiation and remediation of vendor contracts and client supplier relationships to reduce compliance risk, reviewing client policies prior to adoption into Conifer's operations to highlight and address with operations any conflicts between Conifer and client policies and procedures.
Qualification and Experience
Qualifications: Undergraduate degree and law degree from an ABA accredited law school with superior academic credentials. Licensed to practice law. Must have 7+ years legal experience with knowledge of CMS reimbursement regulations and of Medicaid program requirements, as well as an understanding of payor and provider and regulatory issues generally. Must have a thorough understanding of government sponsored healthcare programs, particularly relating to reimbursement issues, including but not limited to CMS and Medicaid programs and of state and federal legislation related to the healthcare industry that affect the payor and provider segment, as well as, contract review and negotiation experience in the commercial insurance payor segment and a thorough understanding of operational challenges from a legal perspective in the health care revenue cycle. Extensive experience in contract review and negotiation is also required.
Job ID: 1705023697