Healthcare Attorney - In House

Our client, a leader in the healthcare field based in the Midwest, seeks an In House Attorney to join their team. This can be a remote position, ensuring compliance with complex healthcare regulations while supporting business objectives. This position requires deep expertise in health insurance law, ERISA compliance, and healthcare regulatory matters, with a strong focus on transactional support for the TPA operations. The Attorney will serve as the primary legal resource for the organization, managing regulatory compliance, contract negotiations, and providing strategic legal guidance to support business growth and risk mitigation. They will work closely with all departments to ensure legal best practices are integrated throughout healthcare administration services while maintaining focus on operational efficiency and client service excellence. Travel to Midwest office will be required 1-2 times a month. The annual compensation range for this position is $120k-$200k. The salary offered within this range will depend upon qualifications and other considerations. Essential Job Responsibilities:

• Health Insurance and ERISA Compliance: Ensure comprehensive compliance with ERISA fiduciary requirements and reporting obligations; Navigate complex health insurance regulations including ACA, HIPAA, COBRA, and state insurance laws; Develop and maintain compliance programs for healthcare benefit administration; Monitor regulatory changes and assess impact on TPA operations; Prepare and review required regulatory filings and documentation; Provide guidance on fiduciary responsibilities and prohibited transaction rules
• Transactional and Contract Management: Draft, review, and negotiate client service agreements and TPA contracts; Manage vendor agreements, including medical provider networks and technology partnerships; Oversee business associate agreements and HIPAA compliance documentation; Support merger and acquisition activities with legal due diligence and documentation; Review and negotiate insurance policies and risk management contracts
• Regulatory Affairs and Government Relations: Maintain relationships with state insurance departments and regulatory bodies; Handle regulatory inquiries, examinations, and enforcement matters; Ensure compliance with state licensing requirements for TPA operations; Monitor legislative developments affecting healthcare administration; Prepare responses to regulatory requests and compliance audit; Coordinate with external regulatory counsel when necessary
• Claims and Benefits Legal Support: Provide legal guidance on complex claims administration issues; Support appeals processes and dispute resolution procedures; Ensure compliance with claims payment and processing regulations; Review benefit plan documents and summary plan descriptions; Handle legal aspects of subrogation and coordination of benefits; Support clinical review and medical necessity determinations
• Risk Management and Litigation Support: Develop and implement legal risk management strategies; Handle employment law matters and workplace compliance issues; Manage professional liability and errors & omissions considerations; Coordinate with outside litigation counsel when necessary; Conduct legal training for staff on compliance and regulatory matters; Oversee data breach response and privacy incident management
• Corporate Governance and Strategic Support: Provide legal counsel to executive team and board of directors; Support corporate governance requirements and board meeting preparation; Coordinate with outside counsel on intellectual property matters including trademarks and copyright filings; Provide legal analysis for strategic business initiatives; Support technology implementations with legal and compliance review; Ensure proper corporate record-keeping and legal documentation

Job Requirements:

• Juris Doctor (J.D.) from an accredited law school
• Active bar admission
• 5+ years of legal experience with focus on healthcare, employee benefits, or insurance law
• Direct experience with ERISA compliance and employee benefit plan administration
• Healthcare industry experience required, with TPA or health insurance background strongly preferred
• Transactional experience including contract negotiation and business transactions
• Experience working with regulatory agencies and handling compliance matters
• Strong litigation management and dispute resolution capabilities

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