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GENERAL SUMMARY OF POSITION:

Under the general direction of the Program Manager, in the Coverage Enhancements and Appeals Program, the Hearings Associate is responsible for the preparation and argument of appeals to any and all responsible third party payors. This includes Medicare, Medicare contractors, and Administrative Law Judges.

MAJOR RESPONSIBILITIES:

Prepare written correspondence for providers, federal and state agencies and courts for Medicare and commercial insurance appeals.
Prepare formal hearing briefs and appear at hearings of assigned case records on behalf of client; typically conducted in front of an Administrative Law judge.
Draft all legal arguments for assigned cases to be presented at Administrative Law Judge hearings.
Review case documents for hearings and obtain missing documentation if needed.
Assist with drafting, obtaining and recording medical attestation statements for final submission into the court record.
Assist with the preparation and retention of project related documentation to ensure compliance with client requirements.
Work with Program Manager to identify strategies and/or successful arguments for all clients.
Assist with the recording of Office of Medicare Hearings and Appeals (OMHA) overflow correspondence when needed.
Performs legal research of relevant Federal Regulations and CMS sub-regulatory materials governing home health providers and services as needed for the development of hearing briefs.
Attend and participate in unit staff meetings as requested
May perform other job related duties as requested or required

REQUIRED QUALIFICATIONS:

• Bachelor's degree or equivalent in Business Administration, Legal Studies or related field
• 3 - 5 years of law related experience under the supervision of an attorney.
  Excellent communication skills, both oral and written to include the ability to explaining alternatives, recommending solutions and/or persuading others towards a course of action.
  Proven ability to provide information to others in a clear and understandable manner and to receive and understand information provided by others.
  Ability to locate and understand applicable federal and state regulations.
  Ability to summarize and analyze legal documents and decisions.
  Advanced computer skills, including Excel, Word, PowerPoint, database entry and information retrieval/reporting and analysis.
  Excellent organizational and time management skills.