Description:
Summary:A Global Health Company's Government Business Segment is a dynamic, mission-driven business that serves over 4 million customers in Medicare Advantage, Part D, ACA Exchange Plans, Medicare Supplement and individual Supplemental Benefit products across the United States. A Global Health Company Legal seeks an experienced attorney to serve as Associate Senior Counsel to provide strategic advice and counsel to the Medicare Advantage Government Business Segment. The position requires a deep understanding of federal healthcare programs, specifically Medicare, including federal and state laws and regulations unique to the health care industry and the application of those laws to business arrangements in the Medicare Advantage health plan.
In a highly complex and evolving regulatory environment, the ideal candidate will provide actionable legal advice on health plan operations, governmental audits, compliance, sales, marketing and broker arrangements, regulator communications and other risk management issues; serve as a strategic partner in developing adaptive strategies, and effectively manage a high volume of matters.
Candidate must demonstrate strong listening, influencing and interpersonal skills with business clients and enterprise colleagues to foster collaboration across businesses and functions to drive results.
Responsibilities:
- Provide strategic, actionable legal advice and counsel to A Global Health Company's Medicare Advantage (including Employer Group Waiver Plans (EGWPs) and D-SNP) programs.
- Provide interpretative and practical advice regarding oversight and compliance requirements of the Medicare Advantage, EGWP and D-SNP programs.
- Advise A Global Health Company Government Business Segment on compliance and risk mitigation; FDR oversight; Medicare medical loss ratio and other financial and reporting requirements; Part C applications and bids; intercompany arrangements and CMS related-party issues; and value-based agreements.
- Support the Medicare Advantage and Part D agent/broker distribution teams on licensing and compensation matters as well as marketing arrangements.
- Collaborate with colleagues across the legal and compliance departments, employing an enterprise mindset.
- Serve as subject matter expert on federal health care laws and regulation, regulatory and enforcement environment affecting the business, including federal and state anti-kickback and self-referral laws, fraud and abuse, False Claims Act liability, government payor billing and reimbursement requirements and payment, government audits and audit readiness, Medicare sales and marketing rules and regulations and compliance programs.
- Serve as a strategic advisor and thought leader to internal clients to achieve enterprise goals while ensuring the highest degree of compliance.
- Collaborate strategically with the business teams and enterprise colleagues on the impact and response to proposed and new rules, regulations and legislation as well as potential legal or compliance risks, including risk mitigation strategies.
- Work closely on daily basis with Medicare Advantage Operations, Sales and Growth, Government Affairs and Compliance.
- Prepare executive facing analyses and risk assessments for internal clients.
Qualifications:
- Juris Doctorate (J/D) from accredited law school/Bar membership required.
- At least 8 years of in-house managed care organization or law firm healthcare experience. Experience advising Medicare Advantage Organizations required.
- Broad knowledge of federal health care programs and health plan operations.
- Strong analytical, written and oral communication skills, including contract drafting and negotiation skills.
- Interpersonal skills to develop and manage relationships with business clients at all levels.
- Demonstrated track record of success in a highly matrixed environment.
- Strong ability to identify issues and propose actionable legal and business solutions.
- Uses a customer-focused and creative approach to problem solving and can efficiently manage a substantial number of issues and competing priorities effectively.
- Strong ability to maneuver through business barriers to facilitate solutions.
- Exceptional track record of project, process and knowledge management.
- Demonstrates resilience and a strong work ethic with effective time-management.
- Demonstrates good judgment and willingness to take on difficult projects.
- Experience in measuring and analyzing process, as well as results, to identify opportunities for improvement.
- This is a Hybrid role and will require someone to be in the office 50% of the time.