Description:
Job Summary:We are actively seeking a highly motivated and ambitious Healthcare Associate Attorney to join our dynamic team, specializing in revenue cycle management for travel emergency claims involving primarily U.S. citizens abroad and other nationals. The ideal candidate will possess a robust knowledge in healthcare law and background in handling complex claims, particularly in the following areas:
- Shortfall payments based on usual and customary rates
- Denials for medical necessity and pre-authorization
- Application of out-of-network benefits to emergency claims
- Implementation of U.S.-based billing guidelines for international claims
Key Responsibilities:
- Claims Management: Review and analyze aging receivables on complex claims, compiling timely appeals and complaints to payors and regulatory authorities.
- Third-Party Coordination: Oversee the referral of third-party claims to external legal partners as necessary.
- Legal Support: File probate cases as required, ensuring efficient service delivery within budgetary constraints by coordinating with external legal partners on litigation matters.
- Policy Implementation: Assist in the development and implementation of departmental policies, goals, objectives, and procedures, collaborating effectively with senior management and staff.
- Quality Assurance: Monitor and contribute to the quality program, ensuring compliance with internal standards and best practices.
- Legal Resource Management: Manage legal hours on cases for rebilling and reporting purposes.
- Strategic Guidance: Provide comprehensive legal strategies on complex claims, directing and coordinating receivables requiring legal escalation, including filing complaints and referring lawsuits to external partners.
- Negotiation and Settlement: Utilize strong negotiation skills, leveraging logic and insurance statutes to defend the medical provider's position while negotiating and settling receivables in accordance with company and client standards.
- Standard Agreements: Review standard agreements for discount and client agreements pertaining to revenue cycle management.
- Reporting: Prepare and submit weekly management reports regarding receivable management for assigned legal cases.
- Billing Preparation: Prepare invoices for specialized billing related to legal fees.
Job Requirements:
- Education: Juris Doctor (JD) degree from an accredited law school.
- Florida Bar: Current membership.
- Experience: Minimum of 3 years of experience in managing complex claims, particularly within the healthcare or insurance sectors.
Knowledge & Skills:
- Strong understanding of the Fair Debt Collection Practices Act.
- Familiarity with HIPAA regulations.
- Proven ability to negotiate effectively, utilizing analytical and communication skills to advocate for medical providers.
- Bilingual in Spanish and English preferred.
Personal Attributes:
- Detail-oriented and organized.
- Ability to thrive in a fast-paced, collaborative environment.
- Strong problem-solving skills and a proactive approach.
- Bilingual in Spanish and English preferred.
Compensation:
This position offers a competitive base salary and a performance-based bonus structure directly tied to the successful closure of assigned cases, rewarding ambition and results.
