Attorney

***$1,000 Relocation bonus!

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.

• 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.

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

• Juris Doctoral Degree (J.D) from an American Bar Association accredited law school.
• Certificates, licenses and registrations required:  
  1. Admission to the bar in the state in which you intend to practice.
• Other skills required: 
  1. Bachelor’s Degree in Law-related field.
  2. Law school GPA of 3.0 or higher.
  3. Must have 3+ years of experience as an attorney.
  4. Basic working knowledge of medical terminology and diagnostic procedures.
  5. Previous coursework and/or work experience in biological sciences or healthcare.
  6. Proficiency in Microsoft Office, including Word and Excel, with the ability to quickly learn and operate new computer programs and software.
  7. Highly attentive to detail and able to handle large amounts of paperwork for a busy office.
  8. Excellent organizational and time management skills.
  9. Clear, concise, and logical writing style.
  10. Able to work independently and efficiently with minimal supervision.

• 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.