Medical Law Specialist

4 weeks ago


St Louis, Missouri, United States CultivaHR LLC Full time

Revenue Cycle Management Expertise

Ternium is a leading provider of premium, professional revenue cycle management services, resolving challenging healthcare insurance claim denials and delays to positive resolution for our partners.

Our mission is to be the trusted partner of health systems and hospitals in their most complex revenue cycle areas, allowing them to focus on patient care.

With our professional and experienced staff, we scale our operating model to meet our partners' needs, driving superior results in net patient revenue and cash flows while reducing operating costs and improving the patient experience.

Key Responsibilities

  • Represent healthcare providers in disputes with medical insurance carriers and managed care organizations across the full spectrum of administrative appeal processes.
  • Leverage your legal education in analytical analysis and issue identification, contract reviews, statutory research and application, and persuasive appeal drafting.
  • Develop a foundational understanding of the industry and strong aptitudes in Commercial and Managed Care Insurance Claims policies and procedures, and ERISA regulations as it relates to administrative processing of claims, claim payment, coverage determinations, dispute resolution, and other relevant concerns.
  • Represent healthcare providers in denied claim disputes, primarily shepherding disputes through an administrative appeals process (no litigation involved).
  • Develop innovative and novel legal and procedural arguments to effectuate positive resolution of denial medical claims.
  • Leverage payor provider manuals and managed care contracts to successfully resolve denied medical claims.
  • Work directly with provider representatives and enhanced resolution units to successfully resolve complex issues.
  • Provide education, payor trends, denial trends, and training of recovery staff team members at partner provider organizations.
  • Conduct legal research and analysis to support business model.

Requirements

  • Ability to adhere to all HIPAA and company policies and regulations.
  • Full-time.
  • Remote.
  • Dental insurance.
  • Employee assistance program.
  • Flexible schedule.
  • Bar Due reimbursement.
  • Ternium's employment practices, including those regarding recruitment, hiring, assignment, promotion, compensation, benefits, training, discipline, and termination shall not be based on any person's age, color, national origin, citizenship status, physical or mental disability, medical condition, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status or any other characteristic protected by federal, state or local law.


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