Legal Associate

is not intended to be all-inclusive; Employee will perform other reasonably related business duties as assigned by the General Counsel and/or administration as required.

General Legal Duties

• Provide comprehensive legal services to DHS including legal interpretation, advice, and representation.
• Provide professional interpretations of law and regulation and make recommendations on issues requiring legal analysis and resolution.
• Provide professional interpretations and recommendations to DHS on issues requiring legal analysis and resolution.
• Advise on regulatory and compliance issues, including Medicare and Medicaid requirements and reimbursement, anti-kickback issues, Stark law, and various other healthcare regulations.
• Prepare, draft, and review legal documents.

Litigation

• Represent DHS in various litigation and regulatory matters, settlement conferences, mediation, arbitration and trial.
• Draft demand letters, pleadings, and motions and take depositions or examinations.
• Assist in discovery, including e-discovery
• Managing litigation and investigations in conjunction with outside counsel

Billing and Revenue Cycle

• Oversee compliance with Medicare, Medicaid, and commercial payer regulations, including applicable billing and payment regulations and coding standards.
• Enforce managed care contracts to ensure compliance with federal and state billing regulations.
• Work directly with the DHS revenue cycle, medical coding, and clinical staff to secure accurate documentation required for aggressive claim recovery.
• Pursue legal action against payors for violations of clean claim laws and untimely or improper payment practices.
• Work directly with Driscoll Health Plan in related claim disputes.
• Represent DHS in mediations, arbitrations, or formal lawsuits related to payor agreements and other audits and disputes.

Regulatory Compliance

• Maintain familiarity with legal and health care regulatory developments.
• Draft, implement, and update institutional compliance policies and standard operating procedures.
• Conduct internal investigations and represent Driscoll in regulatory, payor or government reviews or audits.
• Assist with state licensure, Medicaid/Medicare enrollment and provider-based attestations.

Education and/or Experience

• JD from an accredited law school and admitted to practice law in the state of Texas.
• Five years’ health care legal, regulatory or revenue cycle experience preferred.
• Commercial litigation experience strongly encouraged.
• Excellent written, oral communication and presentation skills.
• Ability to establish and maintain good communications with administration, medical staff, other departments and personnel.