Overview

Job ID 19000CMJ

Available Openings 1

PURPOSE AND SCOPE:

The Assistant General Counsel-Payor Relations:  Provides 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. 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. Maintains a thorough understanding of the company’s business objectives and acts as a trusted business partner for senior management and the organization.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

  • 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. Providesa variety of legal counseland support to functional and/oroperational groups within the company.
  • Manages external legal counsel and other outsourced resources involved in key company projects to optimizeproject outcomes.
  • Assist with various projects as assigned.
  • Other duties as assigned.

Additional responsibilities may include focus on one or more departments or locations.  See applicable addendum for department or location specific functions.

PHYSICAL DEMANDS AND WORKING CONDITIONS:

  • The physical demands and work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
  • May require occasional travel.

EDUCATION:

  • Juris Doctorate Degree from an accredited school required. 

EXPERIENCE AND REQUIRED SKILLS:

  • 5+ years of experience practicing law, either at a law firm, in house or a combination thereof.
  • 2+ years (of the 5+ 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.
  • A strong intellect and solid business acumen.
  • 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.

EO/AA Employer: Minorities/Females/Veterans/Disability/Sexual Orientation/Gender Identity


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