Attorney

***Please note this position can become Hybrid after the probationary period review.

***$1,000 Relocation bonus!

SUMMARY:

This 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:

• Quickly and efficiently reviews medical records and submit well-written appeals to health insurers and governmental payers.
• Maintains an expert understanding of Commercial, Governmental, Managed Care, and ERISA regulations regarding payment, coverage, conditions of participation, and other relevant topics.
• Assists legal appeals team in developing new and innovative legal and procedural arguments and tools.
• Oversees drafting of complex contractual appeals and administrative templates for organizational use.
• Performs administrative duties or projects as assigned by leadership.
• Navigates through various computer systems and applications to find information about insurance claims.
• Navigates through unfamiliar jurisdictions and processes in order to appeal and settle claims.
• Follows all HIPAA guidelines.
• Performs other related duties as assigned by management.

SUPERVISORY RESPONSIBILITIES:

• This job has no supervisory responsibilities, However, might serve as a guidance for Paralegals/Interns.

QUALIFICATIONS:

• Juris Doctoral Degree (J.D) from an American Bar Association accredited law school.
• Certificates, licenses and registrations required:
• Admission to the bar in the state in which you intend to practice.
• Other skills required:
• Bachelor's Degree in Law-related field.
• Law school GPA of 3.0 or higher.
• Must have 3+ years of experience as an attorney.
• Basic working knowledge of medical terminology and diagnostic procedures.
• Previous coursework and/or work experience in biological sciences or healthcare.
• 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.
• Excellent organizational and time management skills.
• Clear, concise, and logical writing style.
• Able to work independently and efficiently with minimal supervision.

COMPETENCIES:

• 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 time
• Customer 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 plan
• Judgement - 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 topics
• Strategic 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.