HMSA

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Strategic Provider Relations Counsel

at HMSA

Posted: 10/2/2019
Job Reference #: 5000481557606
Categories: Other/General
Keywords: company

Job Description

Employment Type

Full-time

Exempt or Non-Exempt

Exempt

Job Summary

You are responsible for leading strategic provider relations efforts for Legal Affairs. Your major duties will include, among other things, partnering with the business areas to advise on, and provide creative solutions for, issues pertaining to federal and state laws regulating HMSA's provider relationships and drafting and reviewing provider contracts (particularly as they pertain to nontraditional provider relationships); you will also be responsible for representing HMSA in disputes with providers including without limitation disputes concerning credentialing of, and contracting with, HMSA's provider partners.

Minimum Qualifications

  • Juris Doctor (JD) degree from an accredited law school
  • 5 years of broad-based legal experience with a prominent law firm, company, or government, or equivalent experience
  • License to practice law in Hawaii or must obtain license within one year of hire in order to continue employment.
  • Effective communication skills
  • Proficient knowledge of Microsoft Office Suite

Duties and Responsibilities

A. Provider Regulatory Counsel and Contracting

 * Develop an expert understanding of areas of law regulating HMSA's provider relationships (including without limitation the federal Stark Law and Anti-Kickback Statute) and strategic business goals, and keep business partners apprised of applicable new laws and their implications, relevant to HMSA's provider relationships and provider contracts.

 * Assess situations with potential legal impact by taking a proactive approach to understanding business needs and advise key business leaders on effective strategic approaches to structure contracts with providers, particularly as to non-traditional provider relationships, while mitigating risk to the company. Ensure that communications take into account legal and business factors and are clear, easy to understand and actionable.

 * Draft and negotiate contracts with providers of various complexities, as well as contracts that bridge both provider and vendor spaces.

 

B. Provider Dispute Facilitation and Resolution

 * Manage pre-litigation/pre-arbitration issues and disputes with providers concerning provider credentialing, including without limitation representing HMSA at internal credentialing hearings and related internal appeals (including managing outside counsel where appropriate), and providing legal and business advice to HMSA's credentialing unit in support of its process and operations.

 * Manage pre-litigation/pre-arbitration issues and disputes with providers concerning participating provider contract status, including without limitation representing HMSA at internal appeals (including managing outside counsel where appropriate), and providing legal and business advice to HMSA's provider contracting unit in support of its process and operations.

 * Manage other external pre-litigation/pre-arbitration complaints and grievances by or concerning providers, including without limitation managing response to regulatory complaints made by or concerning providers.

 * Partner and coordinate with Litigation Counsel with respect to the above as appropriate.

 

C. Other Duties as Assigned

 * Maintain trusting and respectful relationships with the business and be seen as a consultant on both legal and non-legal issues.

 * Constantly look for ways to improve the efficiency of the contracting process, while balancing the need to aid the business in achieving its strategic goals while mitigating risk to the company.

 * Lead resolution of complex legal and business issues by bringing people together and taking leadership of the issue.

 * Partner with other attorneys and paralegals in Legal Affairs on cross-functional matters and matters that require assistance.

 * Participate on projects outside Legal Affairs to broaden perspective of company and help company achieve enterprise goals.

 * Other duties as assigned.