Attorney

Healthcare Legal Solutions AttorneyThis position is responsible for settling a high volume of claims using creative, innovative, and flexible argumentation; managing an ample case load of corporate health claims; filing written appeals through administrative appeals processes to resolve problematic (e.g. underpaid or denied) medical claims for payment with governmental and corporate health payers.Duties and responsibilities include:Quickly and efficiently review medical records and submit well-written compelling appeals to health insurers and governmental payers.Write demand letters and negotiate settlements from large corporate payers.Apply an expert understanding of Commercial, Governmental, Managed Care, and ERISA regulations regarding payment, coverage, conditions of participation, and other relevant topics to support appeal arguments.Assist legal appeals team in developing new and innovative legal and procedural arguments and tools.Oversee drafting of complex contractual appeals and administrative templates for organizational use.Guide legal interns and paralegals when needed.Perform administrative duties or projects as assigned by leadership.Navigate through various insurance systems and applications to find information about insurance claims.Follow all HIPAA guidelines and internal compliance protocols.Required qualifications include:Juris Doctoral Degree (J.D.) from an American Bar Association accredited law school.Licensed to practice law in at least one U.S. jurisdiction (DC, MD, VA, or PA preferred).Law school GPA of 3.0 or higher.3+ years of legal experience, ideally in healthcare or administrative law.Proficiency in Microsoft Office, including Word and Excel, with the ability to quickly learn and operate new computer programs and software.Highly attentive to detail and able to handle large amounts of paperwork for a busy office.Clear, concise, and logical writing style.Excellent organizational and time management skills.Preferred qualifications include:Basic working knowledge of medical terminology and diagnostic procedures.Experience in healthcare claims, denial management, or reimbursement.Ability to work independently and efficiently with minimal supervision.Strong written and verbal communication.Dependability and sound judgement in time-sensitive matters.Team player with collaborative, feedback-oriented mindset.Competencies include:Adaptability - Adapts to changes in the work environment; Manages competing demands; Changes approach or method to best fit the situation; Able to deal with frequent change, delays, or unexpected events.Analytical - Synthesizes complex or diverse information; Collects and researches data; Uses intuition and experience to complement data; Designs work flows and procedures.Attendance/Punctuality - Is consistently at work and on time; Ensures work responsibilities are covered when absent; Arrives at meetings and appointments on timeCustomer Service - Manages difficult or emotional customer situations; Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance; Meets commitments.Dependability - Follows instructions, responds to management direction; Takes responsibility for own actions; Keeps commitments; Commits to long hours of work when necessary to reach goals; Completes tasks on time or notifies appropriate person with an alternate planJudgement - Displays willingness to make decisions; Exhibits sound and accurate judgment; Supports and explains reasoning for decisions; Includes appropriate people in decision-making process; Makes timely decisions.Problem Solving - Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions; Works well in group problem solving situations; Uses reason even when dealing with emotional topicsStrategic Thinking - Develops strategies to achieve organizational goals; Understands organization's strengths & weaknesses; Analyzes market and competition; Identifies external threats and opportunities; Adapts strategy to changing conditions.Teamwork - Balances team and individual responsibilities; Exhibits objectivity and openness to others' views; Gives and welcomes feedback; Contributes to building a positive team spirit; Puts success of team above own interests; Able to build morale and group commitments to goals and objectives; Supports everyone's efforts to succeed.Benefits include:Competitive salary based on experience with opportunity for performance-based bonusesHealth, dental, and vision insurance stipend - Choose your own plan (in process of conversion to group health so this is changing)401(k) retirement plan with company contributionVacation time, sick time, and paid holidaysProfessional development and training opportunitiesSubsidized Life and disability insuranceCommuter benefits