Legal Review Specialist
New
J
J29, IncHealthcare Management
United StatesPart-TimeMiddle
Salary58 - 63 USD per hour
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Job Details
- Experience
- Seven (7) or more years of experience
- Required Skills
- Compliance
Requirements
- Juris Doctor (JD) preferred or Bachelor's degree required.
- 7+ years of experience in Medicare, healthcare regulatory compliance, appeals, program integrity, or federal healthcare programs.
- Experience with Medicare statutes, CFR interpretation, or CMS adjudicatory processes.
- Strong analytical and writing skills.
- Experience supporting CMS, OGC, or federal healthcare programs preferred.
- Ability to interpret agency guidance and sub-regulatory materials.
Responsibilities
- Review appeal determinations, case files, and supporting materials for legal and regulatory sufficiency.
- Analyze complex Medicare policy, statutory, and regulatory issues related to appeals and coverage determinations.
- Advise internal stakeholders on the interpretation and application of Medicare statutes, federal regulations, and agency guidance.
- Assist in the preparation of materials for administrative hearings, adjudicatory reviews, and appeal proceedings.
- Conduct legal and regulatory research to support appeal determinations and program operations.
- Draft and review legal memoranda, policy analyses, and written recommendations.
- Collaborate with clinical reviewers, appeals analysts, and leadership to address complex regulatory issues.
- Monitor changes in Medicare regulations and communicate impacts to stakeholders.
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