Summary: Primary attorney for managed care related payment litagation and disputes on behlf of hospitals, physicican groups, and ambulatory surgery centers.
Community Health Systems ("CHSPSC, LLC") is one of the leading operators of general acute care hospitals. The organization's affiliates own, operate, or lease hospitals in 20 states, with an aggregate of approximately 21,000 licensed beds. The consolidated organization owns and leases community hospitals that offer quality, cost-effective healthcare including a range of inpatient medical and surgical services, outpatient treatment and skilled nursing care. In over 60 percent of the markets served, CHS-affiliated hospitals are the sole provider of healthcare services.
CHSPSC, LLC seeks a Corporate Counsel-Managed Care Payment Enforcement
for its Franklin, TN, headquarters' In- House Legal
Primary attorney for managed care related payment litagation and disputes on behlf of hospitals, physicican groups, and ambulatory surgery centers.Essential Duties and Responsibilities
include the following. Other duties may be assigned.
- Works with and assists the Senior Vice President- Chief Litigation Counsel on various managed care and reimbursement matters;
- Manages and resolves managed care-related payment litigation and disputes, which will include prosecuting payment claims and defending against audits and recoupments;
- Manages outside counsel for managed care-related payment litigation and disputes;
- Interprets laws, rulings, and regulations regarding Medicare Advantage, managed Medicaid, commercial insurance, and other forms of health insurance;
- Interprets contracts between health care providers and managed care entities to enforce payment obligations;
- Investigates managed care payment and dispute trends and opportunities; and
- Supports strategic contracting initiatives.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Therequirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.Language Ability:
Ability to read, analyze, and laws, ruling, regulations and litigation-related documents. Ability to respond effectively to the most sensitive inquiries or complaints. Ability to make effective and persuasive speeches and presentations on controversial or complex topics to senior management.Reasoning Ability:
Ability to apply principles of logical or scientific thinking to a wide range of intellectual and practical problems. Ability to deal with nonverbal symbolism (formulas, scientific equations, graphs, etc.) in its most difficult phases. Ability to deal with a variety of abstract and concrete variables.Computer Skills:
To perform this job successfully, an individual should have knowledge of word processing software, spreadsheet software, and Google Suite.Physical Demands:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.Education/Experience:
Juris Doctor (J.D.) degree and licensed to practice law in the State of Tennessee; at least five years' experience handling managed care-related litigation, disputes, and associated matters. Experience in and understanding of various other aspects