Job Details

Assistant Counsel

Company name

Health Partners Plans, Inc.

Organization Type

In-House

Job Type

Attorney

Date Last Verified

Jun 25,2019

Posted on

Jun 24,2019

Years of Experience

Min 5 yrs required

Location

Philadelphia, PA, United States

Industry

Legal
Practice Area
Corporate >> Corporate
Health Care >> Health Care
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Summary / Objective:

Manage, coordinate and implement a broad range of projects and programs in direct support of Legal Affairs. Serve as Assistant Counsel in Legal Affairs Department, reporting to General Counsel / Vice President, Legal Affairs.  Charged with development, review, tracking and upkeep of contract management tasks for HPP; managing the functions of Subrogation and managing the subrogation staff; as well as handling cases when another party is legally liable for the claims of Plan members; creating, reviewing, monitoring and submitting all regulatory required reports for subrogation and exercising independent judgment and decision making on subrogation cases with guidance provided to staff for handling cases; providing backup support for hearings, administrative law matters and other legal proceedings as necessary; managing litigation internally and in coordination with external counsel; and assisting with research and guidance for corporate legal needs, projects and/or reports as requested by General Counsel.

Essential Functions:

 

  • Able to work in a constant state of alertness and safe manner

 

  • Perform legal research, investigate matters, provide advice and memoranda/opinions, as assigned by General Counsel

 

  • Effectively and efficiently manage contract drafting, editing and negotiations & processes for tracking same in accordance with Company policies and procedures

 

  • Responsible to update all health plan contracts when necessary due to information changes, requirements based on regulations, standards, and/or Company protocol

 

  • Ensuring compliance with Company policies and procedures and regulatory requirements for contract processing, management, negotiations and maintenance/repository of contracts

 

  • Establish and maintain timely and accurate communication channels with other business units to ensure contract process is effective

 

  • Ability to implement standards and requirements of NCQA, CMS, DHS, PID, DOH, internal business units, external or internal auditors, committees or workgroups which impact contracts, legal guidance, research

 

  • Conduct initial and periodic review of contracts relative to financial arrangements, service arrangements, reasonableness, term limits, and other applicable topics
  • Ability to handle multiple complex legal projects in a fast-paced environment
  • Demonstrated experience with health care contracting, provider and payor relationships, and health care regulatory structures including health care fraud, waste and abuse laws and regulations, licensure and certification, healthcare information systems, and Medicare/Medicaid program requirements and reimbursement
  • Assist in developing goals and objectives for the Subrogation staff
  • Handle the issues and processes related to subrogation, reporting, third party liability and attorney lien requests

 

  • Prepare drafts of pleadings and correspondence for internal and external counsel; develop strategy for external counsel and assist external counsel in preparation for litigation; negotiate with outside parties on potential-litigation matters; gather responses to information requests relative to lawsuits, liens, etc.; attend arbitrations, hearings and other court appearances for internal litigation matters and coordinate with external counsel when applicable

 

  • Assist with other projects as directed by the General Counsel.

 

Supervisory Responsibility:

This position has overall supervisory responsibility for subrogation staff and/or others as directed by the General Counsel.

 

Work Environment:

This job operates in a corporate setting.  This role requires regular walking internally around the company and occasionally to libraries, courthouses, other attorney offices, etc.  Filing, using the copy machine, and other administrative activity within the corporate setting is also done on a daily basis.

 

Physical Demands

While performing the duties of this job, the employee is regularly required to talk and hear. This position is fairly active and requires standing, walking, bending, kneeling, and stooping throughout the day.

 

Travel

Occasional local travel required for this position.

Work from Home

This position is not available to work from home

Required Education and Experience:

Education:     Required:  Undergraduate degree; Juris Doctor Degree from accredited Law School; 5+ years’ experience in managed care or health insurer in-house setting or in contracting or legal/compliance department

Skills/Abilities:

Required:

  • Strong negotiations and conflict resolution skills
  • Experience in healthcare contracting, drafting/negotiating and interpreting contracts
  • Knowledge of managed care, Medicaid and Medicare; and, healthcare compliance
  • Litigation skills
  • Working knowledge of subrogation, other party liability, liens
  • Pleasant, courteous, professional, team player
  • Management experience
  • Excellent organizational, interpersonal, time   management and communications skills
  • Superior interpersonal skills, oral and written communication skills and analytical ability.

Preferred:

  • Working experience with PC based applications such as Excel,
  • Access, and Word preferred
  • Process and project management ability
  • In-house healthcare experience

 

Other Duties

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for their job. Duties, responsibilities, and activities may change at any time with or without notice.

Medicare Advantage Compliance Statement:  Compliance with all applicable rules, regulations and laws is a condition of employment.  Employees must read and sign, both the Business Code of Conduct and the Personal Standard Code of Conduct, and are expected to perform their duties ethically and honestly.

Access To Protected Health Information: LA

 

Company info

Health Partners Plans, Inc.

Company Profile

Health Partners Plans is an award-winning, not-for-profit health maintenance organization serving more than 280,000 members in Bucks, Chester, Delaware, Lancaster, Lehigh, Montgomery, Northampton, and Philadelphia counties. We offer Medicaid, Medicare and Children’s Health Insurance Program (CHIP) plans that include special benefits to improve the health and wellness of our members. We’re also committed to boosting the health of our community through outreach, education and events. We continually develop new ways to encourage better health outcomes and have received national recognition for our innovations in managed care.

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