The primary duty of the Legal Analyst is to assist in the Appeals outreach/communications and reconsideration review process with CMS and conduct reviews of appeals requests. The Legal Analyst will also conduct legal coding and privilege reviews of sensitive data. The Legal Analyst will serve as a consultant and SME by researching and analyzing the impact of legislative and regulatory trends and develop recommendations based on legal and policy research in a healthcare environment. Candidates can expect to conduct independent research on issues related to the Medicare Part C Risk Adjustment payment program. The Legal Analyst will have integrated team experience, and the ability to provide consultative guidance on the impact of federal law, proposed federal rules and healthcare policy. The candidate will bring an advanced knowledge of healthcare policy research, legal analysis, and appeals processing expertise.
• Independently identify legal risks and legal strategy for complex legal issues within a consultant environment. • Draft legal memorandums, motions and objections to administrative law and federal healthcare appeals. • Develop consultative solutions • Draft legal responses to administrative appeals requests for Medicare Part C payment error calculation, and privilege documentation review of legal requests. • Review current regulatory developments, undertake required research, prepare complex technical analyses, and develop market-differentiating advice, insights, and solutions related to health and welfare plans. • Analyze key policy, legislative and legal developments, and issues, and share insights and solutions with internal and external clients. • Draft federal laws and healthcare policies. • Conduct Legal Analysis of complex legal issues in a fast-paced work environment • Collaborate with legal staff on legal and policy implications to develop strategic healthcare solutions. • Remain current on proposed and finalized Legislative, Regulatory, and sub-regulatory operational program policies • Draft policy and operations briefings and analyses • Provide project management tracking and reporting • Draft and update policy and operational documentation including but not limited to Manuals, Companion Guides, White Papers, Participant Guides, Standard Operating Procedures, etc. • Serve on cross-functional teams to create internal and external efficiencies. • Perform other duties as assigned
• Juris Doctorate from an ABA accredited law school required; license not required. • 3-5 years of working experience required; healthcare experience preferred • 3-5 years administrative law and/or appeals experience required. • Technical writing experience required • Experience with legal database knowledge • Experience with Federal Healthcare programs (Medicare Advantage desired • Project management experience preferred, Project Management Professional (PMP) certification desired • Curriculum development experience desired • Ability to conduct independent research required • Outstanding written and oral communication skills • Well-developed analytical skills • Ability to meet deadlines in a fast-paced environment • Ability to digest large amounts of technical information and communicate results, issues, risks and impacts in concise manner to a diverse audience • Ability to work efficiently and independently in a remote environment. • Proficiency in using Microsoft Office applications such as Visio, Excel, Word, and PowerPoint • Experience with SharePoint, JIRA and Confluence a plus