About The Role

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.

Healthcare Collections and Reimbursement

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 patient financial services, 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 law laws and untimely or improper payment practices.
Represent DHS in mediations, arbitrations, or formal lawsuits related to payor agreements and other audits and disputes.
Pursue collections, recovery and subrogation of claims as necessary.
Recover unpaid revenue from commercial insurance companies, Medicare, Medicaid, and patients.
Resolve wrongful claim denials, manage underpayment and recoupment disputes, handle regulatory compliance, and revenue cycle conflicts.
Oversee payor disputes on denials, delayed payments, and improper claw backs or recoupment audits.
Handle administrative appeals and compliance matters involving government and commercial payors.
Manage ethical and legally compliant patient collections while observing state itemized billing laws and federal guidelines.
Review allegations related to billing fraud
Enforce statutory deadlines that insurers must follow when paying clean claims.
Navigate compliance with the federal No Surprises Act and state balance-billing protection and Itemized Billing Rules

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.

Education and/or Experience

JD from an accredited law school and admitted to practice law in the state of Texas.
Revenue cycle, medical office billing, regulatory or similar experienced preferred.
Excellent written, oral communication and presentation skills.
Ability to establish and maintain good communications with administration, medical staff, other departments and personnel.