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Associate General Counsel-Managed Care

Work Schedule/Days:  Day / Monday - Friday
Employment Type:  Full-Time
Location:  Support I 
Requisition #:  62543

 

JOB SUMMARY

Provides healthcare law support in the areas of regulatory law and business and professional contracting with an emphasis on major provider agreements, managed care, value-added services, administrative hearings, physician contracting and regulated transactions.

EDUCATION

  • Juris Doctor degree

CERTIFICATION SUMMARY

  • Member in good standing of the State Bar of Georgia

EXPERIENCE*

  • 4 years of legal experience, with 4 years in healthcare including significant contracting responsibility
  • Experience in managed care, payor, or healthcare regulation/legislation/litigation matters
  • Experience in healthcare law and business
  • Experience with dispute resolution and administrative appeals for government and private payors

PREFERRED QUALIFICATIONS*

  • Experience in billing, payment, reimbursement, payor contracting, administrative law hearings and litigation are a must.
  • General knowledge and experience in the Healthcare industry and associated rules and regulations, including Stark, Anti-Kickback, False Claims Act, Antitrust, Privacy and Security is strongly preferred
  • Knowledge of employment law, professional staff issues, FDA regulations, supply chain and academic research are a plus.

KNOWLEDGE SKILLS & ABILITIES*

  • Ability to counsel client departments in matters of contract enforcement, drafting advice and performance, and other areas of law
  • Must be able to facilitate lawful resolutions and solutions to business, regulatory, and professional issues
  • Strong written and oral communication skills
  • Focus on timeliness and ability to meet deadlines
  • Ability to understand and focus on business goals

JOB RESPONSIBILITIES*

  1. Provides counsel to system leaders and client departments. 
  2. When requested, provides legal advice regarding managed care payor agreements (including drafting language when requested, identifying regulatory issues, and assisting with related operational issues).
  3. Provides pre-litigation claim support and analysis for disputes regarding rights and obligations under managed care agreements.
  4. Assists in the analysis of payor policies and compliance with managed care agreements.
  5. Structures agreements between and among affiliates which support the services and functions of Children’s Healthcare of Atlanta and affiliated companies. 
  6. Represents client departments in negotiations and meetings.
  7. Adapts contract templates and existing agreements to changes in regulations and laws relating to healthcare services and professional agreements.
  8. Works with outside counsel as assigned by General Counsel.
  9. Strives to improve internal legal systems and processes.

SYSTEM RESPONSIBILITIES*

Safety: Practices proper safety techniques in accordance with hospital and departmental policies and procedures. Responsible for the reporting of employee/patient/visitor injuries or accidents, or other safety issues to the supervisor and in the occurrence notification system.

 

Compliance: Monitors and ensures compliance with all regulatory requirements, organizational standards, and policies and procedures related to area of responsibility. Identifies potential risk areas within area of responsibility and supports problem resolution process. Maintains records of compliance activities and reports compliance activities to the Compliance Office.

 

The above statements are intended to describe the general nature and level of work performed by people assigned to this classification.  They are not intended to be an exhaustive list of all job duties performed by the personnel so classified.

PHYSICAL DEMANDS*

Ability to lift up to 15 lbs independently not to exceed 50 lbs without assistance
Bending/Stooping - Not Present
Climbing - Not Present
Hearing/Speaking - Effective communication with employees, supervisors/managers and staff. Effective communications with patients and visitors, as required.
Lifting - Occasionally (activity or condition exists up to 1/3 of time)
Pushing/Pulling - Occasionally (activity or condition exists up to 1/3 of time)
Sitting - Constantly (activity or condition exists 2/3 or more of time)
Standing - Occasionally (activity or condition exists up to 1/3 of time)
Walking - Occasionally (activity or condition exists up to 1/3 of time)

WORKING CONDITIONS*

 

Address:  1575 Northeast Expressway, Bldg 1, Atlanta, GA  30329 
Function:  Legal/Compliance - Legal


Nearest Major Market: Atlanta