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Medical Claims Attorney in El Segundo, CA at Avanti Hospitals

Date Posted: 9/4/2018

Job Snapshot

Job Description

Avanti Hospitals, Corporate Office

Job Title: Medical Claims Attorney 

City: El Segundo / State: California    

System Legal

Day Shift

From 9:00 AM

To 5:30 PM

                                      


Job Description and Job Responsibilites

Medical Claims Attorney

Job Description:  Works with the Central Business Office management staff in reviewing denied medical claims and appeal processes and provides advice and recommendations on legal authority and strategy that can be used in such appeals.    Advises on and/or initiates any potential legal action that may be required for upheld denials including appropriate jurisdiction, legal argument and negotiation, when appropriate.

Job Requirements:

  • Knowledge of California Health & Safety Codes as they relate to:
    • Contested Claims
    • Timely Payments
    • Interest payments on delayed claims
    • Payment for Emergency Services
    • Unfair Payment Practices
  • Knowledge of Processes, Rules and Regulations as determined by the Department of Managed Healthcare Services
  • Knowledge of the Rules and Regulations covered by the California Department of Insurance
  • Knowledge of the Rules and Regulations covering insurance claims with ERISA plans
  • Knowledge of the Rules and Regulations covering payment for Medicare Advantage plans
  • Familiarity with managed care contracts and their specific terms and appeal rules
  • Experience with communicating and negotiating with medical payors who have unfairly denied reimbursement of claims
  • Experience with filing and monitoring claims with the Department of Managed Health Care
  • Experience with collections, claims and contract administration in a hospital or healthcare system environment




Job Requirements

Skills & Qualifications:

  • Bachelor’s Degree
  • Paralegal Certificate or Juris Doctor Degree from ABA accredited law school
  • 3-8 years of legal and regulatory experience with a healthcare payor or law firm where the primary responsibility is working with health insurance law and regulations

 

 

Job Requirements

Skills & Qualifications:

  • Bachelor’s Degree
  • Paralegal Certificate or Juris Doctor Degree from ABA accredited law school
  • 3-8 years of legal and regulatory experience with a healthcare payor or law firm where the primary responsibility is working with health insurance law and regulations