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Associate, Legal Analyst, Complex Claims

Job ID: ASSOC01412
Updated: November 10, 2018
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Associate Legal Analyst, Complex Claims

Job Description:

This position will focus on the review and pursuit of complex legal healthcare claims with overlapping issues related to clinical care through review of statutes, regulations, case law, contracts, and medical records. This position will also assist with negotiating settlements, providing high level education on various areas of healthcare law to associates and leadership, and assist in the development of legally-driven procedures to increase revenue. This position, through superior research, writing, and communication skills will influence team members and help develop the Ensemble brand of complex claim resolution.

This position requires that ability to work collaboratively in a fast-paced environment with subject-matter experts in various areas of revenue cycle to provide work product and advisement that is clear, concise, and actionable.

Job Description Summary:
  • Analyze client claims for viability of pursuit through legal escalation.
  • Research statutes, regulations, caselaw, administrative guidelines, notice and comment hearings as needed to produce sound, comprehensive and creative legal arguments.
  • Constantly review government agency statements, regulatory guidelines, and pending bills for application and/or impact to revenue cycle.
  • Develop strategies to resolve systemic payor issues in aggregate.
  • Develop a working knowledge of all facets of claims procedures for government, commercial, and liability payors.
  • Articulate complex issues and provide education and/or advisement that is clear, concise, and actionable.

A Successful Candidate Possesses:
  • JD from an ABA accredited law school preferred.
  • Strong academic credentials; top 50% of class with health, transactional, and administrative law course work.
  • 1-3 years relevant experience with drafting legal documents, negotiating settlement, and reviewing service contracts.
  • Exceedingly detail oriented, organized, and self-motivated.
  • Confidence to respond to inquiries from clients, senior leadership, and other partners in line with the requirements of individual scopes of work.
  • Knowledge of HIPAA, PPACA, and ERISA.
  • Ability to interpret, edit, and audit legal and clinical documentation.
  • Strong interpersonal skills with the ability with work with other attorneys, clinicians, and representatives of clients.
  • An internal drive to succeed and motive those around them.
  • Adaptability to rapid growth and progressing environment within a corporate setting.

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