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Appeals Legal Liaison in Latham, NY at Beacon Health Options

Date Posted: 2/8/2019

Job Snapshot

Job Description

About the Position:

We are currently seeking a dynamic Appeals Legal Liaison to join our team in Latham, NY! The Legal Liaison I functions as the point of contact for legal correspondence received in the service center and submission/resolution of Legal complaints. The incumbent assesses the nature of the legal correspondence and the urgency of the request and completes appropriate documentation for tracking/trending data in the database system.

This position conducts all pertinent research in order to evaluate and summarize claims and clinical issues in order for the legal department to respond to legal inquiries from a variety sources such as the Department of Labor, state attorney general offices, state departments of insurance, state regulatory health agencies, subpoenas, lawsuits, case settlement negotiations etc. and in accordance with all established regulatory guidelines. The legal liaison analyzes legal correspondence and makes solid recommendations based on facts. This includes drafting legal responses for the legal department and identifying critical information and considering alternatives. This includes ensuring that timely decisions are completed and responded to with a sense of urgency.

Position Responsibilities:

  • Develop and implement the necessary processes to manage the receipt, investigation and resolution of legal correspondence within the quality standards and timeframes required

  • Maintain a current knowledge of plan products, policies and procedures with the ability to relate this information in a clear, concise and understandable manner to member, providers, and other customers, both internal and external. 

  • Manage the receipt, investigation and resolution of standard complaint and appeal issues in a timely and highly effective manner.

  • Interface with the appropriate Beacon management and staff at all levels to present and summarize Legal issues to the legal department.

  • Maintain confidentiality of all protected health information in accordance with state and federal guidelines and corporate policies and procedures.

  • Maintain knowledge of all system, contractual, compliance standard changes and policy updates, and attend additional training sessions as necessary

  • Complete projects and other research tasks as assigned by area management.

  • Comply with all HIPAA compliance regulations.

Position Requirements:

  • Education: Bachelor’s Degree required, legal degree preferred 

  • Relevant Work Experience: 3 years’ experience in healthcare in the resolution of legal and appeal issues or a related field is required

  • Knowledge, Skills, & Abilities:

    • Excellent analytical, problem solving, decision making, time management, organizational, presentation, and coaching skills preferred

    • Excellent written, verbal, interpersonal/negotiating skills required.

    • Knowledge of resources available within the organization to resolve internal/external problems and concerns preferred

To Apply:

Click below on “Apply for this Position” to create a profile and apply for the position

Beacon Health Options is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment.  EOE/AA/M/F/Veterans/Disabled

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