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Organization TypePublic Interest
Years of Experience
Managing Counsel DUTIES: Ensures compliance with all applicable laws, regulations and policies. Participates in and influences the decision-making process with appropriate clients and stakeholders. Independently handles legal matters and projects ranging from basic to complex. Recognizes when to elevate certain matters to the attention of the Chief Legal Officer. Provides legal counsel and advice to Company for commercial and government payor programs, Medicare, Medicaid, and third-party payor enrollment and reimbursement matters, HIPAA and Confidentiality of Alcohol and Drug Abuse Patient Records compliance, self-referral prohibition, fraud and abuse analysis, corporate compliance programs, licensure and certification and accreditation. Be the subject-matter expert for commercial and government payor relationships, including exhibiting a deep understanding of Medicare, Medicaid and third-party payor enrollment and reimbursement matters. Be the subject matter expert for regulatory compliance for all laboratory operations, contracting and reimbursement. Review, oversee and manage commercial and government payor contracting, including drafting and negotiating complex contracts, overseeing a compliance appeals process, where appropriate, and handling payor-provider disputes. Lead appropriate payor contract related education and training, including the roll out and implementation of new payor contracts; and assure that new contracts are implemented in a timely and accurate manner. Maintain permanent record of all commercial and government contracts.
Qualification and Experience
Requirements: A JD Degree or equivalent degree from a law school accredited by the American Bar Association required. Admission to the State Bar of Tennessee and professional licensure in good standing without any instances of suspension, revocation, censure or other adverse events in any jurisdiction required. 15+ yearsâ€™ prior legal work experience in a law firm and/or in-house legal department providing counsel in a number of the following areas for various provider types (i.e., behavioral health facilities, labs, hospitals, physician group practices): commercial and government payor programs, Medicare, Medicaid, and third-party payor enrollment and reimbursement matters, HIPAA and Federal Confidentiality of Alcohol and Drug Abuse Patient Records compliance, self-referral prohibition, fraud and abuse analysis, corporate compliance programs, healthcare transactional, licensure and certification and accreditation (required). Experience managing litigation involving commercial and/or government payors disputes is also a plus. Deep knowledge of healthcare laws and regulatory enforcement trends affecting providers (required). Good working knowledge of other substantive legal areas and issues related to healthcare generally, including healthcare business and corporate transactions, compliance, marketing, operations and corporate governance (required). Highly professional and collaborative with ability to influence others, build strong professional relationships and work effectively with multi-disciplinary teams (required). Proven ability to identify and minimize business risks and propose practical solutions to issues across a wide variety of disciplines (required). Self-starter with good business sense and a sense of urgency, honesty and fairness (required). Sound judgment; ability to clearly make reasoned recommendations; ability to cross think and determine who should be kept informed (required). Advanced organizational and project management skills with meticulous attention to detail; ability to manage heavy workload in a high pressure environment (required). Flexibility in work schedule to include some nights, weekends and travel (required). Must be a proven team player willing to pitch-in on projects outside of normal responsibilities. Ability to balance workload amid interruption and change in priorities, potentially multiple times within the same work day (required). Ability to read and interpret written information; write clearly and informatively; edit work for spelling and grammar. Ability to speak clearly and persuasively in positive or negative situations; listen and understand clarification; respond well to questions; demonstrate group presentation skills and participate in meetings. Working knowledge of Microsoft Word, Excel, Outlook, PowerPoint and Adobe Acrobat so as to be self-sufficient in each application. 5+ yearsâ€™ experience with progressive technology for utilization of electronic document storage (PCDocs, Hummingbird, etc.) system, to a level of competent self-sufficiency. If in personal recovery, 2+ years clean and sober. Highest degree of professional ethics and integrity; Outstanding judgment and analytical skills; Strong interpersonal and communication skills. Ability to anticipate legal issues or risks.
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