Senior Legal Counsel

4 hours ago


Austin, Texas, United States TMF Health Quality Institute Full time
Job Title: Senior Legal Counsel

We are seeking a highly skilled Senior Legal Counsel to join our team at TMF Health Quality Institute. As a Senior Legal Counsel, you will be responsible for providing legal representation for the company in administrative law judge (ALJ) hearings in the claims appeal process and providing quality and legal review of pre-adjudicated cases.

Key Responsibilities:
  • Participate in ALJ hearings as an attorney representative of the company in collaboration with the company's medical professionals and representatives from other Centers for Medicare & Medicaid Services (CMS) contractors.
  • Review ALJ decisions and orders received from Office of Medicare Hearings and Appeals (OMHA), as required.
  • Analyze ALJ decisions received from OMHA for reconsideration decision quality purposes and provide training to decision makers to improve the quality of company decisions.
  • Inform Medicare contractors of pending ALJ hearings to the extent required by joint operating agreements.
  • Schedule and lead meetings with other Medicare contractors when pre-hearing coordination is required.
  • Provide quality and legal review, as needed, for high-dollar cases, complex cases, cases with legal representation or sensitive cases to ensure the decision response is of the highest quality.
  • Support contract administration activities, such as Congressional inquiries, Litigation Hold & Document Preservation requests, and Freedom of Information Act (FOIA) requests, as needed.
Requirements:
  • Juris Doctorate degree from an accredited law school.
  • Active membership in state bar.
  • Three (3) years legal experience, preferably in Medicare claims and participation in Administrative or Judicial proceedings.
Benefits:
  • Medical, dental, vision, life, accidental death and dismemberment, and short and long-term disability insurance.
  • Section 125 plan.
  • 401K.
  • Competitive salary.
  • License/credentials reimbursement.
  • Tuition Reimbursement.

TMF Health Quality Institute is an Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities. We are committed to diversity and inclusion in the workplace.


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