Healthcare Provider Advocate

3 weeks ago


Cambridge, Massachusetts, United States Ternium Full time

Overview:

Ternium is seeking a highly skilled Managed Care Attorney Advisor to join our team. As a Staff/Associate Attorney, you will represent healthcare providers in their disputes with medical insurance carriers and managed care organizations across the full spectrum of administrative appeal processes.

This is a non-traditional legal role whereby you will leverage your legal education in a variety of ways, including analytical analysis and issue identification, contract reviews, statutory research and application, and persuasive appeal drafting.

You will develop a foundational understanding of the industry and develop strong aptitudes in the areas of 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.

Key Responsibilities:

  • 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.
  • Draft complex and persuasive appeal letters to insurance organizations and benefit administrators.
  • 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.

Requirements:

  • Juris Doctor required
  • State Bar Membership (preferred)
  • Strong analytical and problem-solving skills
  • Excellent written and verbal communication skills
  • Ability to work independently and as part of a team
  • Attention to detail and the ability to prioritize within a dynamic environment

Benefits:

  • Full-time
  • Remote
  • 401(k) with corporate match
  • Dental insurance
  • Employee assistance program
  • Flexible schedule
  • Health insurance
  • Vision insurance
  • Life insurance
  • Paid time off
  • Bar Due reimbursement
  • Bonus opportunities

EEO Statement:

Ternium is committed to equal employment opportunity and welcomes applications from diverse candidates.



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