Operations Counsel

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Operations Counsel, Managed Care, IPAs and Clinic Operations
Duties: Responsible for supporting certain day-to-day operations for assigned Managed Care, IPAs, and Clinic operations in portfolio. Drafting and developing organizational policies and procedures. Counseling management daily on a range of legal and regulatory issues, including licensure, credentialing, and performance incentives. Working with the Contracting department and operators to structure, develop and draft payor arrangements that maximize reimbursement for services provided or arranged for Health Plan members. Working with the Contracting department and operators to structure, develop and draft a variety of physician arrangements, to properly align interests and ensure compliance with fraud and abuse laws and physician self-referral laws. Working closely with members of Senior Management, including Compliance department. Assisting with internal investigations, including management of outside counsel. Managing payor disputes pertaining to reimbursement, including management of outside counsel and collection vendors. Effectively responding to outside regulatory agencies. Creating and disseminating legal education modules to field personnel related to the requirements of the existing regulatory environment. Developing programs and tools to assist with efficient, compliant day-to-day operations, including the recommendation and implementation of systems. Designing, implementing and monitoring compliant operational structures to meet organizational goals.

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