Associate General Counsel - Payer Contracting

WVU Medicine; Morgantown (WV); Hybride; USD 130 000 - 190 000; Plein temps

Résumé du poste

SYSTEM West Virginia University Health System seeks an Associate General Counsel to provide day-to-day advice on contracting and payer agreements. The role focuses on managed care, reimbursement, credentialing, and provider networks within a large health system.

The candidate will draft, negotiate, and review a broad spectrum of contracts, and advise management on regulatory and compliance matters affecting payors, networks, and value-based care initiatives.

Qualifications

• JD required.
• West Virginia Bar membership or eligibility required.

Responsabilités

• Prepares, reviews, and negotiates a wide range of payer-related agreements including managed care, reimbursement, provider network and other payor contracts.
• Provides legal guidance to management on strategic partnerships, network participation, population health arrangements and regulatory matters.
• Advises payer contracting, finance, and revenue cycle teams on compliance with applicable laws and contracting practices.
• Oversees governance matters related to the organization’s accountable care initiatives and credentialing entities.
• Maintains current knowledge of fraud, abuse, Stark, and regulatory trends relevant to health care contracting.

Connaissances

Contract drafting

Negotiation

Healthcare payor contracts

Regulatory compliance

Legal guidance

Formation

Juris Doctor

Description du poste

Under the supervision of the Chief Legal Officer (CLO) (or his/her designee), the Associate General Counsel is responsible for the day-to-day advice and counsel in the areas of contracting between the West Virginia United Health System, Inc. and the clinical practice plan of West Virginia University (collectively the "Organizations") and commercial health insurance plans, government-sponsored health plans, managed care organizations, and other third-party payers. The Associate General Counsel is responsible for the day-to-day advice and counsel in drafting, negotiating, and reviewing a wide range of agreements, including those in connection with the Organizations’ managed care, reimbursement, provider network, value-based care, accountable care, delegation, credentialing and other payer agreements, and similar contracting and documentation arrangements. The Associate General Counsel is also responsible for providing other general legal advice and guidance to the Organization’s managed care, finance, and revenue cycle teams to evaluate proposed reimbursement arrangements, contract performance, and payer disputes, including, but not limited to disputes related to contract interpretation, reimbursement, denials, audits, and underpayments. The Associate General Counsel is also responsible for other day-to-day duties as assigned by the CLO, the Deputy General Counsel, and/or their designees.

Minimum Qualifications

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

• Juris Doctor required.
• West Virginia Bar membership or eligibility required.

Experience

• Ten (10) years of substantial experience in a law firm or in-house legal department in the areas of corporate, contract, and regulatory law, with preferred experience in the following areas: (i) contract drafting, review, and negotiation, (ii) negotiating and advising on healthcare payor contracts and managed care contracting, and (iii) working within a health system, academic medical center or healthcare provider organization.

CORE DUTIES AND RESPONSIBILITIES:

The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.

• Prepares, reviews, and assists with negotiating a wide range of agreements, including those in connection with the Organizations’ managed care, reimbursement, provider network, value-based care, accountable care, delegation, credentialing and other payor agreements for the Organizations.
• Provides regular legal guidance and advice to the Organizations’ management team on a wide variety of legal and regulatory matters related to strategic partnerships, network participation initiatives, provider affiliations, and population health arrangements.
• Provides day-to-day legal advice to the payer contracting, finance, and revenue cycle teams regarding compliance with all guidelines, laws and contracting matters.
• Provides oversight and legal advice on corporate governance matters related to the Organizations’ accountable care organization and provider credentialing entities.
• Stays current on trends in the law and, particularly, fraud and abuse, Stark, compliance, regulatory, and related matters.
• Is knowledgeable of legal trends and standards which regulate contracting between health care providers and payers and work to ensure compliance with these standards.
• Coordinates with outside counsel when litigation, arbitration, mediation, or regulatory proceedings arise.
• Develop policies and procedures for the agreement submission and review process and drafts template agreements and updates for the payer contracting teams.
• Responds in a timely manner to request for advice or information.
• Prepares and reviews contracts and/or agreements between the Organizations and commercial insurers, Medicare Advantage plans, Medicaid managed care organizations, and other third-party payers as applicable.
• Demonstrates regard for the dignity, respect, and safety of all patients, family members, visitors, and personnel as defined in the philosophy of such organizations.
• Promotes and contributes positively to intradepartmental and interdepartmental relationships.
• Maintains proper attendance and punctuality to ensure that such organizations are operated in an efficient and cost-effective manner.
• Participates in meeting the goals and objectives of the department to ensure that the department contributes to the attainment of such the Organizations’ goals and objectives.
• Diligently and in a responsible and timely manner pursues and addresses legal needs of the Organizations as they arise.
• Oversees one or more assistant general counsel and/or other legal services personnel and staff, providing such support and training as is necessary to develop the skill sets of such counsel, personnel, and staff.
• Provides assistance and back-up coverage for the Deputy General Counsel and/or the CLO or their designees, as needed.

PHYSICAL REQUIREMENTS:

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.

WORKING ENVIRONMENT:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• General office work.
• Remote and/or Hybrid work considered.

Skills And Abilities

• Excellent organizational and interpersonal skills.
• Excellent verbal and written communication skills.
• Ability to manage multiple tasks at one time.
• Ability to work under stress and with short deadlines.
• Ability to solve problems in a timely and practical fashion.
• Knowledge of laws and regulations applicable to health insurers, payers, and managed care companies.
• Knowledge of litigation process and procedures.
• Knowledge of the general operations of non-profit and for-profit corporations, limited liability companies, and joint ventures.
• Knowledge of laws and regulations applicable to hospitals and professional providers preferred.

Additional Job Description

Scheduled Weekly Hours:

40

Exempt/Non-Exempt

Shift:

United States of America (Exempt)

Company

SYSTEM West Virginia University Health System

Cost Center

509 SYSTEM Legal Services

Address

1240 Suncrest Towne Centre
Morgantown
West Virginia

Equal Opportunity Employer

West Virginia University Health System and its subsidiaries (collectively "WVUHS") is an equal opportunity employer and complies with all applicable federal, state, and local fair employment practices laws. WVUHS strictly prohibits and does not tolerate discrimination against employees, applicants, or any other covered persons because of race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, sexual orientation, and gender identity), age, physical or mental disability, citizenship, past, current, or prospective service in the uniformed services, genetic information, or any other characteristic protected under applicable federal, state, or local law. All WVUHS employees, other workers, and representatives are prohibited from engaging in unlawful discrimination. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, training, promotion, discipline, compensation, benefits, and termination of employment.